instructions for completing the florida uniform traffic ... · instructions for completing the...

INSTRUCTIONS FOR COMPLETING THE FLORIDA UNIFORM TRAFFIC

CRASH REPORT FORMS

2008

STATE OF FLORIDA Department of Highway Safety and Motor Vehicles

Neil Kirkman Building Tallahassee, Florida 32399-0500

(Revised May 1, 2008)

Table of Contents Introduction……………………………………………………….. pages 2-3 Long Form Report………………………………………………… pages 4-53 Update/Continuation…………………………………………….… pages 54-57 Short Form Report………………………………………………… pages 58-60 Appendix A (Glossary)…………………………………………… pages 61-67 Appendix B (Trailers)………………………………………….… pages 68-72 Appendix C (County Codes)……………………………………… pages 73-74 Appendix D (City Codes)………………………………………… pages 75-83 Appendix E (State Codes)………………………………………… pages 84-87 Appendix F (Other Terms)………………………………………. pages 88-103 Appendix G (Long Form)……………….……………………….. pages 104-106 Appendix H (Update/Continuation Form)……………………….. pages 107-109 Appendix I (Narrative/Diagram Form)………………………….. pages 110-112 Appendix J (Short Form)……………………………………….… pages 113-115

1

Information About Florida Traffic Crash Report Forms

The Florida Traffic Crash Report is used by law enforcement officers in Florida to report

traffic crashes to the Department of Highway Safety and Motor Vehicles. Traffic crashes can be

reported by the use of two forms commonly referred to as the “Long Form” and the “Short Form.”

A Long Form Report (HSMV 90003) in its entirety includes the Narrative/Diagram report

(HSMV 90005) and any necessary Update/Continuation Report form (HSMV 90004) when the

following criteria are met:

Death or personal injury,

Leaving the scene involving damage to attended vehicles or

property (F.S. 316.061 (1)),

Driving while under the influence (F.S. 316.193),

The Short Form Report (HSMV 90006) is used to report other types of traffic crashes to the

Department: a driver report if the driver is required to file a written report to the Department or as a

driver exchange of information form. If form HSMV 90006 is used as a Short Form, the officer

who investigates the traffic crash is only required to fill in the shaded areas. However, law

enforcement agencies can require their officers to fill in additional information.

The Florida Traffic Crash Reports are completed by filling in the blanks with required

information obtained from an investigation of the event. In some cases, the report displays a list of

values for certain data that pertains to vehicles, drivers, pedestrians, passengers, and the scene of

the traffic crash. The investigating officer is required to select and enter a value in the appropriate

data field. Some data fields are constructed to accept more than one value if warranted. The values

needed to complete the vehicle or pedestrian sections on forms HSMV 90003 (Long Form), HSMV

90004 (Update/Continuation), and passenger information on form HSMV 90005

(Narrative/Diagram) are located on the Long Form at the bottom of page one. The values needed to

2

complete the events section of these forms are displayed next to the data fields on the back of forms

HSMV 90003 and HSMV 90004. The remaining data fields are completed based on the

information requested at the top of each category.

It is important that those who investigate and complete crash reports are doing so uniformly

to ensure accuracy of the data captured from the report and the timely submission of the report to

HSMV within 10 days of completing the investigation as required by F.S. 316.066.

3

FLORIDA TRAFFIC CRASH REPORT

LONG FORM

HSMV 90003 and HSMV 90005

4

Time and Location Information (HSMV 90003)

DATE OF CRASH

DATE OF CRASH

01 30 06

Enter the date of the traffic crash in month, day, and year order in the following manner:

Display the month by using the numbers 01 through 12.

Display the day by using the numbers 01 through 31.

Display the appropriate year as required.

TIME OF CRASH

Enter the time

Place a

Midnig

identif

TIME OFFIC

TIME OF CRASH 1:14 AM PM

TIME OFFICER NOT 1:18

Enter t

Place a

Midnig

identif

of day

n X in

ht is co

y the tim

ER NO

IFIED AM

he time

n X in

ht is co

y the tim

X

or the approximate time of day the traffic crash occurred.

the AM or PM box.

nsidered AM and noon is considered PM. Use the 12-hour clock system to

e of the crash. Do NOT use the 24-hour clock system (a.k.a. military time).

TIFIED

PM
X
of day you were notified of the traffic crash.

the AM or PM box.

nsidered AM and noon is considered PM. Use the 12-hour clock system to

e of the crash. Do NOT use the 24-hour clock system (a.k.a. military time).

5

TIME OFFICER ARRIVED

Enter the time of day you arrived at the scene of the traffic crash.

Place an X in the AM or PM box.

Midnight is considered AM and noon is considered PM. Use the 12-hour clock system to

identify the time of the crash. Do NOT use the 24-hour clock system (a.k.a. military time).

INVESTIGATING AGENCY REPORT NUMBER

TIME OFFICER ARRIVED 1:32 AM X PM

INVEST.AGENCY REPORT NUMBER FHPH06OFF12345

This space is used to identify the investigating law enforcement agency’s report or file number.

Enter the report or file number assigned by the agency.

Enter the same investigating agency report or file number on the Florida Traffic Crash

Report, Narrative/Diagram, HSMV 90005.


Report, Update/Continuation Report, HSMV 90004, if applicable.

HSMV CRASH REPORT NUMBER


12345678 This space is used to identify the eight digit, pre-printed crash report number. A pre-printed crash

report number appears on each Florida Traffic Crash Report, Long Form, HSMV 90003.

Enter the same pre-printed crash report number on the Florida Traffic Crash Report,

Narrative/Diagram, HSMV 90005.

Enter the same pre-printed crash report number on the Update/Continuation Report, HSMV

90004, if applicable.

6

COUNTY/CITY CODE

COUNTY/CITY CODE

13/55

This space is used to identify the county and city codes. Please refer to Appendix C for the correct

county codes and Appendix D for the correct city codes.

Enter the county and city code as required.

Enter 00 for the city code if the traffic crash occurred outside the corporate limits of the city

or in an unincorporated area.

CITY OR TOWN

Example A

Example B

Example C

FEET or MILE(S) N S E W CITY OR TOWN (Check if in City or Town) of Tallahassee X

FEET or MILE(S) N S E W CITY OR TOWN (Check if in City or Town) 10 X of Tallahassee

FEET or MILE(S) N S E W CITY OR TOWN (Check if in City or Town) 45 X of Tallahassee

This space is used to identify the city or town where the traffic crash occurred or the nearest city or

town to the traffic crash scene.

If the crash occurred within the corporate limits of a city (Example A).

If mileage is used (Example B). If feet are used (Example C).

Enter the complete name of the city or town where the traffic crash occurred if it happened

within the legal boundaries of a city or town (Example A) and place an X in the box titled

“Check if in City or Town”.

If the traffic crash occurred outside the legal boundaries of a city or town, enter the

approximate distance in feet or miles to the nearest city or town, the complete name of the

nearest city or town, and place an X in the box that best describes the direction of travel

from the nearest city or town (Examples B and C).

7

COUNTY

COUNTY Leon

This space is used to identify the county where the traffic crash occurred.

Enter the complete name of the county.

NODE NUMBERS

Example A

AT NODE NO. or FEET or MILE(S) FROM NODE NO. NEXT NODE NO. 01234 01235

Example B

AT NODE NO. or FEET or MILE(S) FROM NODE NO. NEXT NODE NO. 5 87654 87653

This space is used to identify relative node numbers (crash reference location numbers) in the

vicinity of the traffic crash. Node numbers are used as a point of reference for counting the

frequency of traffic crashes at the same location. The Florida Department of Transportation (state

roads) and county and municipal traffic engineers (county and city roads) assign the numbers in

support of an active traffic crash location system.

Enter the node number(s) in the spaces provided. If a traffic crash occurred at a location

(intersection, bridge, etc.) where a node number has been assigned, display the number in

the “At Node Number” space and enter the next closest node number on the same road in

the “Next Node No.” space (Example A).

If a traffic crash occurred at a location where a node number has not been assigned, enter the

node number closest to the crash location in the space titled “From Node No.”, and enter the

distance in feet or miles from that node number to the crash location. Identify the next

closest node number on the same roadway that is located on the opposite side of the crash

scene, and enter it in the space titled “Next Node No.” (Example B).

If node numbers are exact (Example A), then cross out the “Feet”, “Miles” and “From Node

No.” boxes. If the node numbers are not exact use (Example B). In Example B, either the

“Feet” or “Miles” box will have to be completed, but not both.

8

NUMBER OF LANES

NO. OF LANES 4

This space is used to identify the number of clearly marked lanes on the roadway(s) of a street, road

or highway.

Enter the total number of lanes on the street, road or highway where the traffic crash

occurred. Do not include turn lanes or safety zones. If impact occurred at an intersection

between vehicles traveling on different streets, roads or highways, place the number of lanes

of the street, road or highway with the highest class of trafficway in the space provided. The

highest class of trafficway can be determined by referring to page 2 of the Florida Traffic

Crash Report, HSMV 90003, under the category “Road System Identifier”. They are listed

in descending rank order.

DIVIDED/UNDIVIDED

1

This space is used to identify if a street, road or highway is classified as divided or undivided.

Section 316.090 (1), Florida Statutes, identifies a divided street, road or highway as “any highway

that has been divided into two or more roadways by an intervening space or by a physical barrier or

clearly indicated dividing section so constructed as to impede vehicular traffic…”

Enter the number 1 or 2 in the space provided.

ON STREET, ROAD OR HIGHWAY

1. DIVIDED 2. UNDIVIDED

ON STREET, ROAD OR HIGHWAY U.S. 90 (State Road 10 or Tennessee Street)

This space is used to identify the name of the street, road or highway where the traffic crash

occurred.

Enter the name of the street, road or highway in the space provided. List the highest class of

trafficway first. Refer to page 2 of the Florida Traffic Crash Report, HSMV 90003, under

the category “Road System Identifier” to determine the class of trafficway. The list is in

descending order. List the next highest classification, local names, or aliases in parentheses.

If the traffic crash occurred in a parking lot, enter the address of the parking lot.

If the traffic crash occurred on private property, enter “private property” and the address.

9

AT THE INTERSECTION OF

Example A

AT THE INTERSECTION OF (street, road or highway) State Road 263 (Capital Circle)

FROM THE INTERSECTION OF

Example B

FEET MILE(S) N S E W FROM INTERSECTION OF (street, road or highway) 1.5 US 27 (State Road 20 or Apalachee Pkwy)

This space is used to identify if the traffic crash occurred within the boundaries of an intersection or

close to an intersection. An intersection crash is any traffic crash where the first harmful event

occurs within the limits of the intersection. Section 316.003 (17), Florida Statutes, provides a

general description of an intersection as “the lateral boundary lines of the roadways of two

highways which join one another at, or approximately at, right angles. . .”

If the traffic crash occurred within an intersection, enter the name of the street, road or

highway that intersects with the previously identified street, road or highway (Example A).

If the traffic crash occurred outside the boundaries of an intersection, enter the name of the

nearest street, road or highway, the distance in feet or miles, and the direction from the

nearest street, road or highway (Example B). List the highest class of trafficway as listed on

page 2 of the Florida Traffic Crash Report, HSMV 90003, under the category “Road System

Identifier”.

10

Vehicle or Pedestrian Sections

HSMV 90003

Sections 1, 2, and 3 are designed to identify vehicle, owner, driver and pedestrian information. The

following instructions for entering data also apply to the vehicle or pedestrian sections on the

Florida Traffic Crash Report, Update/Continuation, HSMV 90004, when it is used as a continuation

report to identify more than three vehicles or pedestrians involved in the same traffic crash. The

violating vehicle or pedestrian is entered in Section 1.

THE MARGIN

This space is used to identify vehicle or pedestrian involvement.

Place an X in the vehicle or pedestrian box. Only one box per section can be marked.

DRIVER ACTION DRIVER 1. Phantom ACTION 2. Hit & Run 3. N/A

Pedestrian Vehicle X

3

This space is used to identify a phantom or hit-and-run driver. A phantom driver is a driver of a

non-contact vehicle who leaves the scene of the traffic crash. A hit-and-run driver is a driver whose

vehicle collides with another vehicle or pedestrian or causes damage to other property and leaves

the scene of a traffic crash.

Enter the number 1 in the space provided if the driver is a phantom driver.

Enter the number 2 in the space provided if the driver is a hit-and-run driver.

Enter the number 3 in the space provided if 1 or 2 does not apply.

11

VEHICLE YEAR

YEAR 02

This space is used to display the last two digits of the vehicle year (manufacturer’s model year) of

any vehicle involved in a traffic crash.

Enter the vehicle year in the space provided.

Enter UK in the space provided if the vehicle year is unknown.

If not applicable, leave blank.

VEHICLE MAKE

MAKE Chev

This space is used to identify the vehicle manufacturer’s trade name (Chevrolet, BMW, Ford, etc.)

of any vehicle involved in a traffic crash.

Enter the first four letters or the complete name of the vehicle make. Do not use a model

name (Impala, F-150, Stratus). For vehicles with only three letters (BMW, Kia, GMC, etc.)

enter the complete name.

Enter UK in the space provided if the vehicle make is unknown.


VEHICLE TYPE TYPE 06

This space is used to identify the type of vehicle involved in a traffic crash. The vehicle type codes

are located at the bottom of page one of the Florida Traffic Crash Report, Long Form, HSMV

90003, in the “Code Information” section.

Enter the vehicle type code in the space provided.

Enter UK in the space provided if the vehicle type is unknown.


Vans that are designed to carry passengers (private or for a fee) must be identified by the vehicle

type code 02 and the proper corresponding vehicle use code; namely, 01, private transportation or

12

02, commercial passengers. Vans that are operated for general commercial use (courier service) or

for transporting cargo (work van carrying tools to the work site) must be identified by the vehicle

type code 02 and the proper corresponding vehicle use code; namely, 02, commercial cargo or 15,

cargo van. A vehicle that resembles a van in construction but has six tires on the ground (UPS or

similar delivery van) must be coded as a truck based on the gross vehicle weight (GVW) rating of

the vehicle in question.

Trucks are classified by the gross vehicle weight (GVW) rating of the unit involved in the traffic

crash. There are three categories of trucks based on GVW rating: light trucks, vehicle type code 03

(single unit under 10,000 pounds), medium trucks, vehicle type code 04 (single unit 10,000 to

26,000 pounds), and heavy trucks, vehicle type code 05 (single unit over 26,000 pounds). Truck

tractors (cab, bobtail) have a separate vehicle code, type 06, that must be used for identification

purposes. The GVW rating appears on a label or tag affixed to single-unit trucks and truck tractors

manufactured for use in the United States. The label is placed on the door or door frame next to the

driver’s seat.

Buses have been divided into two separate vehicle types, codes 08 and 09, based on the total

number of passengers the bus was designed to legally transport. A low speed vehicle (code 15) is

any 4-wheel electric vehicle that has a top speed greater than 20 miles per hour but not greater than

25 miles per hour. A low speed vehicle can be operated on streets under certain conditions, must be

licensed for use on the highway, and its operator must have a valid driver’s license. A golf cart is

not considered a low speed vehicle. All vehicle types must have a corresponding vehicle use code.

VEHICLE USE USE 03

This space is used to identify additional vehicle characteristics. The vehicle use codes are located

on page one of the Florida Traffic Crash Report, HSMV 90003, in the “Code Information” section.

Enter the vehicle use code in the space provided.

Enter UK in the space provided if the vehicle use is unknown.


13

It is important that the vehicle type and vehicle use agree in terms of what the vehicle is designed to

do or how it is being used. If an automobile, vehicle type 01, is being used as a taxi, then the

correct vehicle use is 02 (commercial passengers). If a bus, vehicle type 09, is being used to

transport students to school, then the correct vehicle use is 05 (public school bus) or 06 (private

school bus). If the same type of bus is owned by or leased to a government entity for the purpose of

providing transportation to citizens, even for free, then the correct vehicle use is 04 (public

transportation). If the same type of bus is owned by a company for the purpose of transporting

passengers for profit (Greyhound, etc.), then the correct vehicle use is 02 (commercial passengers).

If a heavy truck, vehicle type 05, is designed to transport and deliver cement to a work site, then the

correct vehicle use is 13 (concrete mixer).

VEHICLE LICENSE NUMBER VEH. LICENSE NUMBER PEB21X

This space is used to identify the vehicle license plate number of the vehicle supplying power.

Enter the vehicle license plate number of the vehicle involved in the space provided. Enter it

exactly as it appears on the license plate.

Enter UK in the space provided if unknown.


STATE

STATE FL

This space is used to identify the state that issued the vehicle license plate.

Enter the state of issuance. Please refer to Appendix E for the correct state codes.



14

VEHICLE IDENTIFICATION NUMBER

VEHICLE IDENTIFICATION NUMBER 1FALP20X159832594

This space is used to identify the vehicle identification number (VIN) of the vehicle supplying

power.

Enter the complete VIN in the space provided.



The VIN is a set of numbers generated by the vehicle manufacturer that describes the characteristics

of a vehicle in a coded format. The VIN is recorded on a metal plate located at the bottom of the

windshield on the driver’s side of the vehicle. The VIN also appears inside the driver’s door on a

label affixed to the doorjamb.

FIRST POINT OF VEHICLE DAMAGE

13 14

7

11 12 9 10

5 6 4 2 3

1 16 17 8 15

18 Undercarriage 19 Overturn 20 Windshield 21 Trailer

SHOW FIRST POINT OF VEHICLE DAMAGE AND CIRCLE DAMAGED AREA(S)

1

This space is used to identify the first point of vehicle damage and other damaged areas sustained

by a vehicle in a traffic crash. The first point of vehicle damage is that part of the vehicle that first

collides with another vehicle or object.

Enter the first point of vehicle damage in the space provided by selecting the corresponding

number from the diagram provided. On the diagram, circle all areas of damage including

the first point of damage.

For pedestrians, leave blank.

15

TRAILER OR TOWED VEHICLE GENERAL INFORMATION

This record is used to identify all trailers or towed vehicles involved in traffic crashes. This

information must be completed for traffic crashes involving trailers that are being towed, trailers

that are unhitched (properly or improperly parked), and all other driverless towed vehicles.

Any vehicle which is being towed and guided by a driver positioned behind the steering wheel must

appear in a separate vehicle or pedestrian section.


TRAILER OR TOWED VEHICLE YEAR YEAR 98

This space is used to identify the model year of the trailer or towed vehicle.

Enter the year of the trailer or towed vehicle in the space provided.

Enter UK in the space provided if the vehicle year is unknown.


TRAILER OR TOWED VEHICLE MAKE

MAKE Mack

This space is used to identify the vehicle manufacturer’s trade name of a trailer or towed vehicle.

Enter the first four letters or the complete name of the vehicle make. Do not use a model

name (Impala, F-150, Stratus). For vehicles with only three letters (BMV, Kia, GMC, etc.)

enter the complete name.



16

TRAILER OR TOWED VEHICLE TYPE

TRAILER TYPE 01

This space is used to identify the type of trailer or towed vehicle involved in the traffic crash. The

trailer type codes are located on page one of the Florida Traffic Crash Report, HSMV 90003, in the

“Code Information” section. (See Appendix B for photos of trailer types.)

Enter the trailer type code (09 for towed vehicle) in the space provided.



If tandem trailers (trailer type 02) are involved in a traffic crash, then the second set of trailer

information must appear on the Florida Traffic Crash Report, Update/Continuation, HSMV 90004.

Utility trailers (trailer type 06) also include enclosed rental trailers, horse trailers, and trailers used

by lawn services. Towed vehicle (trailer type 09) applies to other driverless vehicles being towed

by a wrecker or another vehicle.

VEHICLE LICENSE NUMBER – TRAILER OR TOWED VEHICLE

VEH. LICENSE NUMBER P95XYJ

This space is used to identify the vehicle license plate number of the trailer or towed vehicle.

Enter the vehicle license plate number of the vehicle involved in the space provided.



STATE – TRAILER OR TOWED VEHICLE

STATE FL

This space is used to identify the state that issued the vehicle license plate to the trailer or towed

vehicle.

Enter the state of issuance. Please refer to Appendix E for the correct state codes.



17

VEHICLE IDENTIFICATION NUMBER – TRAILER OR TOWED VEHICLE

VEHICLE IDENTIFICATION NUMBER 3XYG74529YY908213

This space is used to identify the vehicle identification number (VIN) assigned to the trailer or

towed vehicle.

Enter the complete VIN in the space provided.



The VIN is a set of numbers generated by the vehicle manufacturer that describes the characteristics

of a vehicle in a coded format. The VIN is recorded on a metal plate located at the bottom of the

windshield on the driver’s side of the vehicle. The VIN also appears inside the driver’s door on a

label affixed to the doorjamb.

VEHICLE TRAVELING

VEHICLE TRAVELING ON AT Est. MPH N S E W X US 90 (State Road 10/Tennessee Street) 55

This space is used to identify the direction and name of the street, road or highway the vehicle or

pedestrian was traveling on when the traffic crash occurred. This space is also used to identify the

estimated speed of the vehicle.

Enter the name of the street, road or highway each vehicle or pedestrian was traveling on in

the space provided. If the impact occurred in a parking lot or on private property, enter the

address of the location.

Enter the direction of travel on the street, road or highway prior to the impact by placing an

X in the correct box.

Enter the estimated speed of the vehicle involved in the traffic crash.



18

POSTED SPEED

Posted Speed 55

This space is used to identify the posted speed for the street, road or highway the vehicle or

pedestrian was traveling on at the time the traffic crash occurred.

Enter the posted speed, or if none, the statutory required speed in the space provided.



ESTIMATED VEHICLE DAMAGE EST. VEHICLE DAMAGE $ 4,500

This space is used to identify the estimated property damage sustained by a vehicle involved in a

traffic crash. All estimates of damage must be displayed numerically and rounded off to the

nearest dollar amount.

Enter the estimated amount of damage in the space provided if the vehicle involved was

damaged.

Enter the estimated amount of damage in the space provided if the vehicle was totaled. Do

not enter the word “totaled.”

Enter “0” in the space provided if the vehicle was not damaged.


If a vehicle owner or driver is found to be uninsured at the time of the crash, and if the driver was

issued a moving traffic citation, the Bureau of Financial Responsibility may require the owner or

driver to post security equal to the estimated amount of vehicle damage.

19

DAMAGED SEVERITY

1 1. Disabling 2. Functional 3. No Damage

This space is used to identify to what extent a vehicle is damaged. There are three categories for

assessing damage severity to a vehicle:

Disabling damage – vehicle must be towed from the scene of the traffic crash because it is

inoperable or is drivable but must be towed from the scene of the traffic crash to prevent

additional damage. This does not include a drivable vehicle that is towed from the scene of

the traffic crash for any other reason.

Functional damage – vehicle is operable and is driven away from the scene of the traffic

crash in its usual operating manner.

No damage – no visible signs of damage.

• Enter the appropriate damage severity code in the space provided.

• If not applicable, leave blank.

A traffic crash involving only disabling damage may be reported on the Florida Traffic Crash

Report, Long Form, HSMV 90003, or the Law Enforcement Short Form, HSMV 90006, as required

by F.S. 316.066 (3)(a)(3).

ESTIMATED TRAILER OR TOWED VEHICLE DAMAGE

EST. TRAILER DAMAGE $ 1,000

This space is used to identify the estimated property damage sustained by a trailer or towed vehicle

involved in a traffic crash. All estimates of damage must be displayed numerically and rounded

off to the nearest dollar amount.

Enter the estimated amount of damage in the space provided if the trailer or towed vehicle

involved was damaged.

Enter the estimated amount of damage in the space provided if the trailer or towed vehicle

was totaled. Do not enter the word “totaled.”

Enter a “0” in the space provided if the trailer or towed vehicle was not damaged.


20

MOTOR VEHICLE INSURANCE COMPANY (LIABILITY OR PIP)

MOTOR VEHICLE INSURANCE COMPANY (LIABILITY OR PIP) POLICY NUMBER State Farm Insurance Company SJ109-6578

This space is used to identify the motor vehicle insurance company and policy number of the

vehicle owner or driver. The best source for obtaining this information is a valid motor vehicle

insurance identification card, a valid insurance policy, a valid insurance binder, or a certificate of

self insurance issued by the Department of Highway Safety and Motor Vehicles.

Enter the name of the motor vehicle insurance company in the space provided.

Enter the valid policy number, self insurance certificate number or the word “binder” in the

space provided.



VEHICLE REMOVED BY

VEHICLE REMOVED BY: 1. Tow Rotation List 3. Driver

B&D Towing 2. Tow Owner’s Request 4. Other 1

This space is used to identify the name of the person, garage, or wrecker service that removed the

vehicle from the scene of the traffic crash and how the vehicle was removed.

Enter the name of the person, garage, or wrecker service in the space provided.

Enter 1, 2, 3, or 4 in the box provided to indicate how the vehicle was removed from the

scene of the traffic crash.



NAME OF VEHICLE OWNER

NAME OF VEHICLE OWNER (Check Box if Same As Driver)

Jacob B. Sampson

This space is used to identify the owner of the vehicle involved in the traffic crash.

Enter the first name, middle initial, and last name of the person who owns the vehicle.

Enter only one name if joint ownership is established.

Enter the words “Same as Driver” if the owner and driver are the same and place and X in

the box provided.

21

Enter the full legal name of any company or corporation that owns the vehicle.



VEHICLE OWNER CURRENT ADDRESS

CURRENT ADDRESS (Number and Street) CITY AND STATE ZIP CODE 9627 Main Street Stuart, FL 32948

This space is used to identify the current physical address or mailing address of the owner of the

vehicle involved in the traffic crash.

Enter the street address or mailing address, city, state abbreviation, and zip code of the

person who owns the vehicle.

If a company or corporation owns the vehicle, enter the address or mailing address, city,

state abbreviation, and zip code of the company or corporation.

Do not abbreviate the name of the city.

Use the standard, two-letter postal abbreviation for all states.



NAME OF OWNER (Trailer or Towed Vehicle)

NAME OF OWNER (Trailer or Towed Vehicle)

J&J Auto Leasing, Inc.

This space is used to identify the owner of the trailer or towed vehicle.

Enter the first name, middle initial, and last name of the person who owns the trailer or

towed vehicle.

Enter only one name if joint ownership is established.

Enter the full legal name of any company or corporation that owns the vehicle.



22

TRAILER OR TOWED VEHICLE OWNER CURRENT ADDRESS

CURRENT ADDRESS (Number and Street) CITY AND STATE ZIP CODE 8365 S. Hampton Road Stuart, FL 32948


trailer or towed vehicle involved in the traffic crash.


person who owns the trailer or towed vehicle.

If a company or corporation owns the trailer or towed vehicle, enter the address or mailing

address, city, state abbreviation, and zip code of the company or corporation.





NAME OF MOTOR CARRIER (Commercial Vehicle Only)

This space is used to identify the name of the motor carrier. A motor carrier is “the business entity,

individual, partnership, corporation, or religious organization responsible for the transportation of

goods, property or people.”

NAME OF MOTOR CARRIER (Commercial Vehicle Only)

International Trucking

Enter the name of the motor carrier in the space provided. If the motor carrier is a person,

enter the first name, middle initial, and last name. If the motor carrier is a company or

corporation, enter the full legal name of the company or corporation.



This space must be completed for any self-propelled vehicle – with or without a trailer – being used

in commerce to transport cargo, passengers, or any vehicle displaying a hazardous material placard

including a van (vehicle type code 02), a light truck with six tires on the ground (vehicle type code

03), a medium truck (vehicle type code 04), a heavy truck (vehicle type code 05), a truck-tractor

(vehicle type code 06), a bus designed to transport 9 to 15 passengers (vehicle type code 08), and a

bus designed to transport over 15 passengers (vehicle type code 09).

23

The shipping papers that drivers carry in the cab of the truck are the best source for identifying the

name of the motor carrier. The name on the side of the truck can be different from the person or

company responsible for the movement of the cargo or passengers. It is not unusual for a tractor

and semi-trailer to display different company names.

Example: John Smith owns a truck-tractor (bobtail). He contracts with White Manufacturing

Company to take one of its trailers loaded with its goods from New York to Los Angeles. John

Smith is the motor carrier because his is the entity that has agreed to carry this particular load.

Example: John Smith, driving his truck-tractor, utilizes a cargo broker to obtain goods from

Intermodal Incorporated Shipping Company for his return trip to New York. On the return trip,

John Smith is again the carrier.

Example: John Smith, driving his truck-tractor, leases his services to Polyester Chemical

Company. Polyester Chemical Company has a contract to transport chemicals for a company based

in St. Louis and directs John Smith to deliver a semi-trailer from New York to St. Louis. In this

case, Polyester Chemical Company is the motor carrier because it told John Smith to deliver the

particular load.

Example: John Smith is driving a tractor/semi-trailer. The tractor and semi-trailer are owned

by ABC Trucking, so ABC Trucking is the motor carrier.

Example: John Smith is driving a tractor owned by ABC Trucking which has been leased to

XYZ Trucking Company. XYZ uses the tractor to pull XYZ trailers in its regular shipping service.

In this case, XYZ is the motor carrier because XYZ is directing the carrying of the load.

MOTOR CARRIER CURRENT ADDRESS

CURRENT ADDRESS (Number and Street) CITY, STATE AND ZIP CODE 325 151st Street North Miami, FL 32948


motor carrier involved in the traffic crash.


motor carrier.



24


If not applicable, leave blank

US DOT OR ICC MCC IDENTIFICATION NUMBERS

7 US DOT or ICC MCC IDENTIFICATION NUMBERS 46 1 3 9 5 0

This space is used to identify the United States Department of Transportation (US DOT) or the

Interstate Commerce Commission Motor Carrier (ICC MC) identification number assigned to the

motor carrier.

Enter the US DOT identification number, if applicable, in the space provided. The US DOT

number will have six or seven digits that are entered right-justified. Use zeros to fill any

remaining boxes at the left of the series.

Enter the ICC MC identification number, if applicable, in the space provided. The ICC MC

number may have up to six digits that are entered right-justified. Use zeros to fill in any

remaining boxes to the left of the series. In some cases, a motor carrier could have two or

more ICC MC numbers. Officers should choose only one to record.



A US DOT or an ICC MC identification number is issued to private fleet and for-hire vehicles

involved in interstate commerce. The US DOT identification number is found only on vehicles of

interstate private carriers (those trucks operating in the furtherance of any commercial enterprise).

The identification number is always preceded by the abbreviation US DOT. The ICC MC

identification number is found only on vehicles of interstate for-hire carriers (those in the

transportation business). The identification number is usually preceded by the abbreviation ICC

MC. In some cases it may be preceded by just ICC or MC. Vehicles that haul exempt commodities

are not required to have a US DOT or an ICC MC number even if they travel across state lines. A

motor carrier may have more than one ICC MC number. Officers should choose to record only one.

State numbers are issued by a state agency to vehicles that operate either in interstate commerce or

only within that state. Do not record the state number.

25

NAME OF DRIVER OR PEDESTRIAN

NAME OF DRIVER (Take From Driver License)/PEDESTRIAN

Sarah Ruth Martin

This space is used to identify the name of the driver of the vehicle or the name of the pedestrian

involved in the traffic crash. A driver is “any person who drives or is in actual physical control of a

vehicle on a highway or who is exercising control of a vehicle or steering a vehicle being towed by

a motor vehicle” (Florida Statute 316.003 (10)).

Enter the first name, middle initial, and last name of the driver or pedestrian in the space

provided. This format is used to display the name of a licensed driver on the Florida Driver

License. It must be used even if an out of state driver license is different or if a driver does

not have a driver license. If a driver has changed his or her name since the last issue date of

the driver license, enter the driver’s first name, middle initial, last name, and the name

change in parentheses.

Enter the first name, middle initial, and last name of the driver if the vehicle involved in the

traffic crash was illegally parked. Do not enter the name of the driver if the vehicle was

legally parked and the driver’s seat was unoccupied when the collision occurred.

Enter UK in the space provided if the name of the driver or pedestrian is unknown.

DRIVER OR PEDESTRIAN CURRENT ADDRESS

CURRENT ADDRESS (Number and Street) CITY, STATE AND ZIP CODE 38625 Yulee Avenue Tallahassee, FL 32399

This space is used to identify the current physical address or mailing address of the driver of the

vehicle or the pedestrian involved in the traffic crash.


driver or pedestrian in the space provided.




26

DRIVER OR PEDESTRIAN DATE OF BIRTH

DATE OF BIRTH

08-16-62

This space is used to identify the date of birth of the driver of a vehicle or the pedestrian involved in

a traffic crash.

Enter the date of birth of the driver or pedestrian in month, day and year sequence using two

digits for each.


DRIVER LICENSE NUMBER

This space is used to identify the driver license number of the vehicle driver.

DRIVER LICENSE NUMBER

M655-192-62-954-0

Enter the driver license number exactly as it appears on the driver license in the space

provided.

Enter “none” in the space provided if the vehicle driver does not have a driver license.



The driver license number is used to identify and update the driver history record. It is very

important to enter the correct driver license number on the traffic crash report and ensure that this

number matches the driver license number on any traffic citations issued as a result of the traffic

crash.

DRIVER LICENSE STATE

This space is used to identify the state that issued the driver license.

STATE

FL

Enter the state that issued the driver license in the space provided. Please refer to Appendix

E for the correct state codes.



27

DRIVER LICENSE TYPE

This space is used to identify the type (class) of driver license issued to the vehicle driver. The

driver license type codes are located on page one of the Florida Traffic Crash Report, HSMV

90003, in the “Code Information” section.

DL TYPE

1

Enter the driver license type in the space provided.

Enter code 7 in the space provided if the driver license type is unknown, not required, or if a

pedestrian is involved in the traffic crash.

The driver license type (class) codes verify that the driver in question has been tested and licensed

to operate certain types of vehicles. Class A, B, and C driver licenses are required in order to drive

commercial vehicles. A Class D driver license is required for a chauffeur license, and a Class E for

an operator or restricted operator.

DRIVER LICENSE REQUIRED ENDORSEMENTS

REQ. END.

1

This space is used to identify if the driver license issued to the vehicle driver required any other

special endorsements for the type of vehicle being operated. The required endorsement codes are

located on page one of the Florida Traffic Crash Report, HSMV 90003, in the “Code Information”

section.

Enter a 1 in the space provided if the driver license presented is correctly endorsed. For

example, the driver is operating a motorcycle and is authorized to operate a motorcycle.

Enter a 2 in the space provided if the driver license presented is not correctly endorsed. For

example, the driver is operating a motorcycle without a motorcycle endorsement.

Enter a 3 in the space provided if an endorsement is not required. For example, the driver is

operating an automobile for private transportation.


28

ALCOHOL/DRUG TEST TYPE

5 ALC/DRUG TEST TYPE 1 Blood 3 Urine 5 None 2 Breath 4 Refused

This space is used to identify the type of test a law enforcement officer required to determine if a

vehicle driver or pedestrian involved in a traffic crash is under the influence of alcohol or a

controlled substance.

Enter the alcohol/drug test code in the space provided for all drivers and pedestrians.

ALCOHOL/DRUG TEST TYPE RESULTS

RESULTS

This space is used to identify the results of any test a law enforcement officer required to determine

if a vehicle driver or pedestrian involved in a traffic crash is under the influence of alcohol or a

controlled substance.

Enter the alcohol/drug test results in the space provided for all drivers and pedestrians.

Enter UK in the space provided if the alcohol/drug test results are not known or if they

cannot be revealed on the Florida Traffic Crash Report, HSMV 90003, for legal reasons.

Use the Florida Traffic Crash Update/Continuation, HSMV 90004, to report the results

when they are known or it is permissible to reveal them.


Enter “PEN” in the space provided if the alcohol/drug test results are pending. Use the

Florida Traffic Crash Update/Continuation Report, HSMV 90004, to report the results when

they are known. Results must be listed in this space, not explained on the narrative form.

ALCOHOL/DRUG USE

ALC/DRUG

1

This space is used to identify if a vehicle driver or pedestrian had consumed alcohol or a controlled

substance prior to being involved in a traffic crash. The alcohol/drug use codes are located on page

one of the Florida Traffic Crash Report, HSMV 90003, in the “Code Information” section.

29

Enter the appropriate alcohol/drug use code in the space provided.

Enter a 6 in the space provided if the alcohol/drug test type results are pending. Use the

Florida Traffic Crash Report, Update/Continuation, HSMV 90004, to update the

alcohol/drug use when the results are obtained.

PHYSICAL DEFECTS

PHYS.DEF.

1

This space is used to identify any physical defects attributed to a vehicle driver or pedestrian

involved in a traffic crash. The physical defects codes are located at the bottom of page one on the

Florida Traffic Crash Report, Long Form, HSMV 90003, in the “Code Information” section.

Enter the appropriate physical defect code in the space provided.

RESIDENCE

RES.

1

This space is used to identify demographic information about the vehicle driver or pedestrian. The

residence codes are located at the bottom of page one on the Florida Traffic Crash Report, Long

Form, HSMV 90003, in the “Code Information” section.

Enter the appropriate residence code in the space provided.

RACE

RACE

1

This space is used to identify the race of a vehicle driver or pedestrian involved in a traffic crash.

The codes are located at the bottom of page one on the Florida Traffic Crash Report, Long Form,

HSMV 90003, in the “Code Information” section.

Enter the appropriate code in the space provided.

30

SEX

SEX

2

This space is used to identify the gender of a vehicle driver or pedestrian involved in a traffic crash.

The codes are located at the bottom of page one on the Florida Traffic Crash Report, Long Form,

HSMV 90003, in the “Code Information” section.

Enter the appropriate code in the space provided.

INJURY SEVERITY

INJ.

3

This space is used to identify the severity of injuries sustained by a vehicle driver or pedestrian

involved in a traffic crash. The injury codes are located on page one of the Florida Traffic Crash

Report, HSMV 90003, in the “Code Information” section.

Enter the appropriate injury code in the space provided.

Non-incapacitating injuries are non-disabling injuries, such as lacerations, scrapes, bruises,

etc. Incapacitating injuries are disabling injuries, such as broken bones, severed limbs, etc.

Incapacitating injuries usually require hospitalization and transport to medical facility.

Fatal injuries are those resulting in a death within 30 days of a traffic accident.

SAFETY EQUIPMENT

S. EQUIP.

2 4

This space is used to identify the type(s) of safety equipment the driver of a vehicle was using at the

time of the traffic crash. The safety equipment codes are located on page one of the Florida Traffic

Crash Report, HSMV 90003, in the “Code Information” section.

Enter the appropriate safety equipment code(s) in the space provided. Sometimes more than

one type of safety equipment device was in use. For example, seatbelt/shoulder harness

(code 2) and air bag – deployed (code 4). An officer should record both types of safety

equipment.


31

EJECTED

EJECT.

1

This space is used to identify if the driver of a vehicle involved in a traffic crash was ejected. The

ejection codes are located on page one of the Florida Traffic Crash Report, HSMV 90003, in the

“Code Information” section.

Enter the appropriate ejected code in the space provided.


HAZARDOUS MATERIALS BEING TRANSPORTED

1 HAZARDOUS MATERIALS BEING TRANSPORTED 1 Yes 2 No

This space is used to identify if any vehicle involved in the traffic crash was carrying a hazardous

material as cargo.

Enter 1 in the space provided if a hazardous material was being carried. This does not

include the fuel needed to propel the vehicle supplying power.

Enter 2 in the space provided if a hazardous material was not being carried.


PLACARDED

2 PLACARDED 1 Yes 2 No

This space is used to identify if the vehicle carrying a hazardous material as cargo displayed a

hazardous material placard as required by federal law.

Enter 1 in the space provided if a hazardous material placard was displayed.

Enter 2 in the space provided if a hazardous material placard was not being displayed.


There are two shapes of placards – diamond or rectangular. Vehicles carrying hazardous materials

are required by law to display a placard that identifies the specific name of the hazardous material

32

cargo. In addition, vehicles carrying hazardous materials in tank cars, cargo tanks, or portable tanks

are required to display the 4-digit hazardous materials number assigned to the specific material on

placards or orange panels.

TYPE OF HAZARDOUS MATERIAL

IF YES, INDICATE NAME OR 4 DIGIT NUMBER FROM DIAMOND OR BOX ON PLACARD, AND 1 DIGIT NUMBER FROM BOTTOM OF DIAMOND

This space is used to identify the type of hazardous material being carried, if any.

Enter the 4-digit number or the name of the hazardous material in the space provided. This

information is extracted from the middle of the diamond shaped placard or from the

rectangular shaped placard. If the 4-digit number is not displayed, the placard should have

one of the following names: explosives, gases, flammable liquid, flammable solid,

dangerous, oxidizer, poison, radioactive, or corrosive. Enter the 1-digit number located at

the bottom of the diamond, if it is displayed, in the space provided. When multiple placards

are displayed on the vehicle, enter the information from only one of the placards.

If not applicable or for pedestrians, leave blank.

HAZARDOUS MATERIAL SPILLED

2 WAS HAZARDOUS MATERIAL SPILLED? 1 Yes 2 No

This space is used to identify if the hazardous material (placarded cargo) was released from the

cargo tank or compartment of the vehicle as a result of the traffic crash.

Enter 1 in the space provided if hazardous material was released. (This includes large

amounts of fuel spilled from a vehicle.)

Enter 2 in the space provided if the hazardous material was not released.


33

RECOMMEND DRIVER RE-EXAM

2 RECOMMEND DRIVER RE-EXAM, IF YES EXPLAIN IN NARRATIVE 1 Yes 2 No

This space is used to identify if the driving ability of a vehicle driver is questionable.

Enter 1 in the space provided if the ability of the driver to operate a vehicle is questionable.

Enter 2 in the space provided if the ability of the driver to operate a vehicle is not questionable.


Section 322.126 (2), (3), Florida Statutes, provides that “any physician, person, or agency having

knowledge of any licensed driver’s or applicant’s mental or physical disability to drive is authorized

to report such knowledge to the Department.” The decision to require the driver to submit to

another driver license exam is made by the law enforcement investigator. In making this

assessment, the investigator should take into account obvious driver physical defects, coordination,

reflexes, and perception. If a driver’s ability is questionable, you must explain your reasons in the

narrative section of the Florida Traffic Crash Narrative/Diagram Report, HSMV 90005. The

explanation must be a separate notation following your crash narrative.

DRIVER’S TELEPHONE NUMBER

DRIVER’S PHONE NO.

( ) UK

This space is used to identify the telephone number of the driver.

Enter the driver’s or pedestrian’s telephone number.


Enter NONE in the space provided if the driver or pedestrian has no telephone number.

34

Property Damage – Other Than Vehicle Section

HSMV 90003

PROPERTY DAMAGED OTHER THAN VEHICLES

# PROPERTY DAMAGED – OTHER THAN VEHICLES EST. AMOUNT OWNER’S NAME ADDRESS CITY STATE ZIP

1 Chain link fence $ 600 John’s Drywall 13 2nd Ave Tallahassee, FL 32310

# PROPERTY DAMAGED – OTHER THAN VEHICLES EST. AMOUNT OWNER’S NAME ADDRESS CITY STATE ZIP

2 Oak Tree $ 300 City of Tallahassee 305 Park Ave Tallahassee, FL 32399

This space is used to identify damage to other kinds of property. Do not record damage to a

vehicle, trailer, or driverless towed vehicle in this section.

Enter the type of property damaged, such as a fence, telephone pole, mailbox, street marker,

animal, tree, or damage to cargo that was being carried by another vehicle.

Enter the estimated damage amount rounded to the nearest dollar.

Enter the owner’s name, street or mailing address, city, state, and zip code.

Use the standard, two-letter postal service abbreviation for all states. Please refer to

Appendix E for the correct state codes.

Use the Florida Traffic Crash Report, Update/Continuation, HSMV 90004, to record more

than two instances of damage to property other than vehicles.


35

Events Section

HSMV 90003

This section is designed to identify vehicle, driver, pedestrian, and crash scene characteristics. It is

important to remember that code entries must correspond to the vehicle or pedestrian section they

are intended to represent. Vehicle or pedestrian sections are identified by the number at the top of

each box or series of boxes. Some vehicle or pedestrian data fields may have spaces for multiple

codes. Enter the primary code in the first space and, if applicable, any subsequent codes in the

remaining spaces.

CONTRIBUTING CAUSES DRIVER/PEDESTRIAN

CONTRIBUTING CAUSES – DRIVER/PEDESTRIAN 01 No Improper Driving/Action 1 2 3 02 Careless Driving (Explain in Narrative) 03 Failed to Yield Right-of-Way 77 01 04 Improper Backing 05 Improper Lane Change 06 Improper Turn 07 Alcohol – Under Influence 08 Drugs – Under Influence 09 Alcohol & Drugs – Under Influence 10 Followed Too Closely 11 Disregarded Traffic Signal 12 Exceeded Safe Speed Limit 19 Improper Load 13 Disregarded Stop Sign 20 Disregarded Other Traffic Control 14 Failed To Maintain Equip./Vehicle 21 Driving Wrong Side/Way 15 Improper Passing 22 Fleeing Police 16 Drove Left of Center 23 Vehicle Modified 17 Exceeded Stated Speed Limit 24 Driver Distraction 18 Obstructing Traffic 77 All Other (Explain in Narrative)

This classification is used to identify improper driver or pedestrian action(s) that may have

contributed to the traffic crash. The codes are listed vertically for each driver or pedestrian.

Enter the primary contributing cause code in the first box for each driver or pedestrian. This

must be completed for each driver or pedestrian. For example, if section 1 driver’s vehicle

rear-ended section 2 driver’s vehicle, the officer might conclude that the main contributing

cause of the crash was section 1 driver’s failure to use due care. The officer would record

the primary contributing cause in the first box for section 1 driver as code 77 (see example)

because no code is designated for failure to use due care. The officer would then make a

notation in the narrative explaining code 77 as “failure to use due care”. In this example,

36

section 2 driver was not driving improperly; therefore, the officer would record code 01 for

section 2 driver (see example).

If applicable, enter additional contributing cause codes (up to three maximum) for each

driver or pedestrian.

If code 02, 24, or 77 is used, a separate notation must be made on the Florida Traffic Crash

Report, Narrative/Diagram, HSMV 90005, to explain and identify the contributing factors.

This notation must be listed separately below the last sentence of the narrative section.

Leave each box that is not used blank.

VEHICLE DEFECT

VEHICLE DEFECT 01 No Defects 1 2 3 02 Def. Brakes 03 Worn/Smooth Tires 02 01

04 Defective/Improper Lights 05 Puncture/Blowout 06 Steering Mech. 07 Windshield Wipers 08 Equipment/Vehicle 77 All Other Defect (Explain in Narrative)

This classification is used to identify vehicle mechanical and equipment defects.

Enter the primary vehicle defect code in the first box for each vehicle.

If applicable, enter additional vehicle defect codes for each vehicle.

If code 77 is used, a separate notation must be made on the Florida Traffic Crash Report,

Narrative/Diagram, HSMV 90005, to explain. This notation must be listed separately below

the last sentence of the narrative section.


VEHICLE MOVEMENT

VEHICLE MOVEMENT 01 Straight Ahead 1 2 3 02 Slowing/Stopped/Stalled 03 Making Left Turn 01 02 04 Backing 05 Making Right Turn 11 Passing 06 Changing Lanes 12 Driverless or 07 Entering/Leaving/Parking Space Runaway Vehicle 08 Properly Parked 77 All Other (Explain 09 Improperly Parked (In Narrative) 10 Making U-Turn

This classification is used to identify vehicle movement of each vehicle prior to the time of crash.

Enter the vehicle movement code in the space provided.

37





VEHICLE SPECIAL FUNCTIONS

This classification is used to identify special operating conditions of a vehicle involved in a traffic

crash.

VEHICLE SPECIAL FUNCTIONS 1 None 1 2 3 2 Farm 3 Police Pursuit 1 4 Recreational 5 Emergency Operation 6 Construction/Maintenance

1

Enter the special function code in the space provided.


SOURCE OF CARRIER INFORMATION

SOURCE OF CARRIER INFORMATION 1 Not Applicable 1 2 3 2 Shipping Papers 3 Vehicle Side 2 1 4 Driver 5 Other

This classification is used to identify the means used to obtain the name and address of the motor

carrier who was responsible for directing the movement of cargo or passengers.

Enter the carrier information code in the space provided.

If code 5 is used, explain and identify the source of carrier information in the Florida Traffic

Crash Report, Narrative/Diagram, HSMV 90005.

38

POINT OF COLLISION

POINT OF COLLISION 01 On Road 1 2 3 02 Not On Road 03 Shoulder 01 01 04 Median 05 Turn Lane

This classification is used to identify where the first point of contact between vehicles or

pedestrians occurred.

Enter the point of collision code in the space provided.


WORK AREA

WORK AREA 01 None 1 2 3 02 Nearby 03 Entered 01 01

This classification is used to identify the proximity of a work area to a traffic crash involving a

vehicle or pedestrian.

Enter the work area code in the space provided.


A work area is defined as that area designated by the presence of a flag person, cones,

barricades, drums, arrow boards, pavement markings, signage or other traffic control used to

separate workers and their equipment from other functions. This includes work areas related

to servicing manholes, tree trimming, road work, and other activities that may have some

influence on traffic. The presence of workers at the time of the crash is not needed to define

the work area. The work area codes should be used in the following manner: None (01), no

work area relevant to the traffic crash scene; nearby (02), designated work area in the

vicinity of the traffic crash; and entered (03), during the sequence of events related to the

traffic crash, one ore more of the involved vehicles or pedestrians were within the

boundaries of a designated work area.

39

PEDESTRIAN ACTION PEDESTRIAN ACTION 01 Crossing Not at Intersection 07 Working 1 2 3 02 Crossing at Mid-block Crosswalk in Road 03 Crossing at Intersection 08 Standing/Playing 04 Walking Along Road With Traffic in Road 05 Walking Along Road Against Traffic 09 Standing in Pedestrian Island 06 Working on Vehicle in Road 77 All Other (Explain in Narrative) 88 Unknown

4

This classification is used to identify what the pedestrian was doing prior to the traffic crash.

Enter the pedestrian action code in the space provided. Ensure that the pedestrian action

code is placed only in the vehicle or pedestrian section in which it pertains. In the

example above, if sections 1 and 2 are vehicles and section 3 is a pedestrian, leave the

spaces for section 1 and 2 blank and the appropriate pedestrian action code in the section

3 box.

If code 77 is used, a separate notation must be made on the Florida Traffic Crash

Report, Narrative/Diagram, HSMV 90005, to explain. This notation must be listed

separately below the last sentence of the narrative section.


LOCATION TYPE

This classification is used to describe specific land use characteristics in the area of the traffic crash.

LOCATION TYPE 1 Primarily Business 1 2 Primarily Residential 3 Open Country

Enter the location type code in the space provided. If the area of the crash is primarily

surrounded by businesses, then code 1 would be used. If the area of the crash is primarily

surrounded by homes, then code 2 would be used. If the area of the crash is primarily

surrounded by woodlands, then code 3 would be used.

40

FIRST/SUBSEQUENT HARMFUL EVENT(S)

This classification is used to identify the first and subsequent harmful events for each vehicle or

pedestrian.

FIRST/SUBSEQUENT HARMFUL EVENT(S) 1 2 3 01 Collision With MV in Transport (Rear End) 15 Collision With Animal 29 MV Ran Into Ditch/Culvert 02 Collision With MV in Transport (Head On) 16 MV Hit Sign/Sign Post 30 Ran Off Road Into Water 03 Collision With MV in Transport (Angle) 17 MV Hit Utility/Pole/Light Pole 31 Overturned 04 Collision With MV in Transport (Left Turn) 18 MV Hit Guardrail 32 Occupant Fell From Vehicle 05 Collision With MV in Transport (Right Turn) 19 MV Hit Fence 33 Tractor/Trailer Jackknifed 06 Collision With MV in Transport (Sideswipe) 20 MV Hit Concrete Barrier Wall 34 Fire 07 Collision With MV in Transport (Backed Into) 21 MV Hit Bridge/Pier/Abutment/Rail 35 Explosion 08 Collision With Parked Car 22 MV Hit Tree/Shrubbery 36 Downhill Runaway 09 Collision With MV on Roadway 23 Collision With Construction Barricade Sign 37 Cargo Loss or Shift 10 Collision With Pedestrian 24 Collision With Traffic Gate 38 Separation of Units 11 Collision With Bicycle 25 Collision With Crash Attenuators 39 Median Crossover 12 Collision With Bicycle (Bike Lane) 26 Collision With Fixed Object Above Road 77 All Other (Explain In 13 Collision With Moped 27 MV Hit Other Fixed Object Narrative) 14 Collision With Train 28 Collision With Moveable Object On Road

01 01

Enter the first (primary) harmful event in the space provided for each vehicle or pedestrian.

If applicable, enter any subsequent harmful events in the spaces provided.





Please note code 09 should state "Collision with MV on Other Roadway." The word "other"

was omitted on the crash form 90003, January 2002 revision.

ROAD SYSTEM IDENTIFIER

ROAD SYSTEM IDENTIFIER 01 Interstate 07 Forest Road 02 U.S. 08 Private Roadway 03 State 77 All Other (Explain 04 County In Narrative) 05 Local 06 Turnpike/Toll

02

This classification is used to identify the primary road system on which the traffic crash occurred.

Use the highest road system classification assigned to a particular street, road or highway.

Enter the road system identifier code in the space provided. The list provided is in

descending order for codes 01 through 08.




41

The road system identifier code 06 (turnpike/toll) must be entered for various urban

expressway toll facilities as well as the Florida Turnpike.

LIGHTING CONDITION

LIGHTING CONDITION 01 Daylight 02 Dusk 03 Dawn 04 Dark (Street Light) 05 Dark (No Street Light) 88 Unknown

01

This classification is used to identify the lighting condition at the time of the traffic crash.

Enter the lighting condition code in the space provided.

ROAD SURFACE CONDITION ROAD SURFACE CONDITION 01 Dry 02 Wet 03 Slippery 04 Icy 77 All Other (Explain In Narrative)

01

This classification is used to identify the surface condition of the street, road or highway at the time

of the traffic crash.

Enter the road surface condition code in the space provided.




WEATHER CONDITIONS

WEATHER 01 Clear 02 Cloudy 03 Rain 04 Fog 77 All Other (Explain In Narrative)

03

This classification is used to identify the weather conditions at the time of the traffic crash.

Enter the weather condition code at the time of the crash in the space provided.

42




ROAD SURFACE TYPE

This classification is used to identify the surface construction of the street, road or highway on

which the traffic crash occurred.

ROAD SURFACE TYPE 01 Slag/Gravel/Stone 02 Blacktop 03 Brick/Block 04 Concrete 05 Dirt 77 All Other (Explain In Narrative)

02

Enter the road surface type code in the space provided.




ROAD CONDITIONS AT TIME OF CRASH

ROAD CONDITIONS AT TIME OF CRASH 01 No Defects 02 Obstruction With Warning 03 Obstruction Without Warning 01 04 Road Under Repair/Construction 05 Loose Surface Materials 06 Shoulders – Soft/Low/High 07 Holes/Ruts/Unsafe Paved Edge 08 Standing Water 09 Worn/Polished Road Surface 77 All Other (Explain In Narrative)

This classification is used to identify the road conditions of the street, road or highway on which the

traffic crash occurred.

Enter road condition(s) in the space(s) provided.





If codes 07, 08, or 09 are documented, then the officer should contact the proper authorities

(city, county, or state) to notify them of the hazards.

43

VISION OBSTRUCTED

VISION OBSTRUCTED 01 Vision Not Obstructed 02 Inclement Weather 03 Parked/Stopped Vehicle 04 Trees/Crops/Bushes 05 Load On Vehicle 06 Building/Fixed Object 07 Signs/Billboards 08 Fog 09 Smoke 77 All Other (Explain In 10 Glare In Narrative)

01

This classification is used to identify if the driver’s or pedestrian’s vision was obstructed prior to

the traffic crash.

Enter the vision obstructed code(s) in the space(s) provided.





TRAFFIC CONTROL

TRAFFIC CONTROL 01 No Control 02 Special Speed Zone 03 Speed Control Sign 04 School Zone 05 Traffic Signal 11 Posted No U-Turn 06 Stop Sign 12 No Passing Zone 07 Yield Sign 77 All Other (Explain In 08 Flashing Light Narrative) 09 Railroad Signal 10 Officer/Guard/Flagperson

01

This classification is used to identify traffic control devices in the immediate area of the traffic

crash.

Enter the traffic control code(s) in the space(s) provided.





44

SITE LOCATION

SITE LOCATION 01 Not At Intersection/RR X-ing/Bridge 02 At Intersection 03 Influenced By Intersection 04 Driveway Access 05 Railroad 11 Private Property 06 Bridge 12 Toll Booth 07 Entrance Ramp 13 Public Bus Stop Zone 08 Exit Ramp 77 All Other (Explain In 09 Parking Lot – Public Narrative) 10 Parking Lot – Private

01

This classification is used to identify the site location traffic crash.

Enter the site location code in the space provided.




TRAFFICWAY CHARACTER

This classification is used to identify the characteristics of the trafficway in the area of the traffic

crash.

TRAFFICWAY CHARACTER 01 Straight – Level 02 Straight – Upgrade/ Downgrade 03 Curve – Level 04 Curve – Upgrade/ Downgrade

01

Enter the trafficway (roadway) character code in the space provided.

TYPE SHOULDER

TYPE SHOULDER 01 Paved 02 Unpaved 03 Curb

01

This classification is used to identify the type of roadway shoulder in the area of the traffic crash.

Enter the type of shoulder code in the space provided.

If there are two types of shoulders, such as paved and curbed, then choose the shoulder type

that is closest in proximity to the traffic crash point of impact location.

45

VIOLATOR(S)

SECTION # NAME OF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER

V

iola

tor(

s)

1 Ruth Ann Martin 316.185 Failed to Use Due Care – Special Hazards (rain) AHG1234 SECTION # NAME OF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER



This classification is used to identify each vehicle driver or pedestrian who was given a citation for

a traffic violation by the law enforcement officer who investigated the traffic crash.

In the spaces provided, enter the correct section number, the name of the violator (driver or

pedestrian) who was given the traffic citation, the Florida Statute number, the type of charge,

and the citation number.

If more than four citations are issued, then list the subsequent citations in the violator data fields

on the Florida Traffic Crash Report, Narrative/Diagram, HSMV 90005. Additional violator

data fields appear on the Florida Traffic Crash Report, Update/Continuation, HSMV 90004, if

needed.


The section number must correspond to the driver or pedestrian who was issued a traffic citation. If

a vehicle owner (who was not driving) or a passenger is issued a citation for an infraction, do not

enter that information in the violator data fields.

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Narrative/Diagram

HSMV 90005

This report is used to describe and diagram the traffic crash scene and to identify passengers. It is

always used in conjunction with the Florida Traffic Crash Report, Long Form, HSMV 90003. The

date of the traffic crash, the county/city code, the investigating agency report number, and the

HSMV pre-printed crash report number must be identical on the Long Form and Narrative/Diagram

pages.

TIME EMS NOTIFIED (Fatalities only)

Enter the time of day that emergency medical services were notified of the traffic crash if it

involves a fatality.



identify the time EMS was notified of the traffic crash. Do NOT use the 24-hour clock

system (a.k.a. military time).

TIME EMS ARRIVED (Fatalities only)

TIME EMS NOTIFIED (FATALITIES ONLY)

12:16 AM PM X

TIME EMS ARRIVED (FATALITIES ONLY)

12:30 AM PM X

Enter the time of day that emergency medical services arrived at the traffic crash scene if it involves

a fatality.



identify the time EMS was notified of the traffic crash. DO NOT use the 24-hour clock

system (a.k.a. military time).

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DATE OF CRASH

DATE OF CRASH 01 18 06

Enter the date of the traffic crash in month, day, and year order in the following manner:

Display the month by using the numbers 01 through 12.

Display the day by using the numbers 01 through 31.

Display the appropriate year as required.

The date of the crash must be identical to the date of the crash on page one of the Florida

Traffic Crash Report, Long Form, HSMV 90003.

COUNTY/CITY CODE

COUNTY/CITY CODE

13/00

This space is used to identify the county and city codes. Please refer to Appendix C for the correct

county codes and Appendix D for the correct city codes.

Enter the county and city code as required.

Enter 00 for the city code if the traffic crash occurred outside the corporate limits of the city

or in an unincorporated area.

The county/city code must be identical to the county/city code on page one of the Florida

Traffic Crash Report, Long Form, HSMV 90003.

INVESTIGATING AGENCY REPORT NUMBER

INVEST.AGENCY REPORT NUMBER FHPH06OFF12345

This space is used to identify the investigating law enforcement agency’s report or file number.

Enter the report or file number assigned by the agency.

The investigating agency report or file number must be identical to the investigating agency

report or file number on page one of the Florida Traffic Crash Report, Long Form, HSMV

90003.


Report, Update/Continuation Report, HSMV 90004, if applicable.

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This space is used to identify the eight digit, pre-printed crash report number. A pre-printed crash

report number appears on each Florida Traffic Crash Report, Long Form, HSMV 90003.


12345678

In the space provided, enter the same HSMV pre-printed crash report number as provided on

page one of the Florida Traffic Crash Report, Long Form, HSMV 90003.

Enter the same pre-printed crash report number on the Update/Continuation Report, HSMV

90004, if applicable.

NARRATIVE

(NARRATIVE) Vehicle #1 was traveling south on State Road 263 (Capital Circle) directly behind Vehicle #2. Vehicle #2 driver slowed due to traffic slowing ahead. Vehicle #1 driver observed Vehicle #2 slowing and took evasive action by braking and skidding approximately 26 feet. As a result, the front of Vehicle #1 collided with the rear of Vehicle #2. Upon my arrival, both vehicles were at final rest on the west shoulder of State Road 263 facing south.

Describe what happened prior to, at, and post collision for each vehicle and pedestrian in a

chronological sequence of events. Ensure that the correct section number is used when referring to

specific vehicles, drivers or pedestrians. If additional space is needed, use Florida Traffic Crash

Report, Update/Continuation, HSMV 90004.

PASSENGERS

SEC# PASS# PASSENGER’S NAME CURRENT ADDRESS CITY & STATE ZIP CODE DATE OF BIRTH RACE SEX LOC INJ S. EQUIP. EJECT.

1 1 Abraham J. Ross 1298 Lilac Court Bishop, FL 32852 12/04/80 1 1 3 3 2 5 1

This space is used to identify all passengers riding within or on a vehicle. This includes passengers

riding in the back of a pickup truck and people riding illegally on the exterior of the vehicle. The

passenger information must be provided for all passengers regardless of injuries or non-injuries.

Enter the correct section number. This number must be identical to the vehicle or pedestrian

section number controlling the vehicle the passenger was riding in or on at the time of the

traffic crash.

Enter the passenger number(s) for all passengers riding in or on the same vehicle.

Enter the name, current address, city, state, and zip code for each passenger.

Enter the date of birth for each passenger.

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Enter the elements for identifying the race, sex, location, injury, safety equipment, and

ejected codes for each passenger. The codes are located on page one of the Florida Traffic

Crash Report, Long Form, HSMV 90003, in the “Code Information” section.

Use the Florida Traffic Crash Report, Update/Continuation, HSMV 90004, if more space is

needed for additional passengers.

VIOLATOR(S)



Vio

lato

r(s)

This classification is used to identify each vehicle driver or pedestrian who was given a citation for

a traffic violation by the law enforcement officer who investigated the traffic crash. This section is

used for additional violations not listed on page 2 of the Florida Traffic Crash Report, Long Form,

HSMV 9003. Do not re-enter the same violations.

In the spaces provided, enter the correct section number, the name of the violator (driver or

pedestrian) who was given the traffic citation, the Florida Statute number, the type of charge,

and the citation number.

If there are no additional violations, leave blank.

Additional violator data fields appear on the Florida Traffic Crash Report, Update/Continuation,

HSMV 90004, if needed.

The section number must correspond to the driver or pedestrian who was issued a traffic citation. If

a vehicle owner (who was not driving) or a passenger is issued a citation for an infraction, do not

enter that information in the violator data fields.

WITNESS NAME

WITNESS NAME (1) CURRENT ADDRESS CITY & STATE ZIP CODE

This space is used to identify anyone who witnessed the traffic crash.

Enter the name, current address, city, state, and zip code for each witness.

If there are no witnesses, leave blank.

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FIRST AID GIVEN BY

2 FIRST AID GIVEN BY – NAME 1. Physician or Nurse 2. Paramedic or EMT 3. Police Officer 4. Certified 1st Aider 5. Other

Leon County EMS This space is used to identify if first aid was administered at the scene of the traffic crash.

If a rescue unit responds to the traffic crash scene, enter the name of the rescue unit that

provided first aid. An individual name is not necessary. For example, Leon County EMS is

sufficient with code 2.

Enter the name of the person administering first aid and the code (1, 3, or 4) that best

identifies him/her.

If code 5 is used, enter the name of the person in the space provided.

INJURED TAKEN TO

INJURED TAKEN TO:

Tallahassee Memorial Hospital

This space is used to identify the name of the hospital or facility that received the injured drivers,

pedestrians, or passengers.

Enter the complete name of the hospital or facility.

If emergency medical personnel (EMS) responded to the traffic crash scene to provide first

aid to the injured parties but the parties refused to go to a medical facility with EMS, then

enter “Refused transport” in the space provided.

BY – NAME

BY – NAME

Leon County EMS

This space is used to identify the name of the person or agency that transported the injured drivers,

pedestrians, or passengers to a medical facility or hospital.

Enter the complete name of the person or agency.

Enter “N/A” if the injured parties refused transport to a medical facility or hospital.

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WAS INVESTIGATION MADE AT SCENE

WAS IF NO, THEN WHY? INVESTIGATION 1. YES MADE AT SCENE? 2. NO 1

This space is used to identify if the investigation was made at the traffic crash scene.

Enter the number 1 in the space provided if the investigation was made at the traffic crash

scene.

Enter the number 2 in the space provided if investigation was conducted elsewhere. Then,

enter the address of the location where the investigation was conducted and why it was

completed there.

IS INVESTIGATION COMPLETE

This space is used to identify if the investigation is complete.

Enter the number 1 in the space provided if the investigation is complete.

Enter the number 2 in the space provided if the investigation is not closed and then explain

why it is not complete. The crash report should be updated within 30 days if it is not closed

and then updated each 30 days thereafter until the report is closed.

DATE OF REPORT

IS IF NO, THEN WHY? INVESTIGATION 1. YES COMPLETE? 2. NO 1

DATE OF REPORT

01 31 06

This space is used to identify the date the traffic crash report was completed.

Enter the date the report was completed in month, day, and year sequence using two digits

for each character.

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PHOTOS TAKEN

PHOTOS IF YES, BY WHOM? TAKEN 1. YES 1. INVESTIGATING AGENCY

2. NO 2. OTHER 2

This space is used to identify if photographs were taken at the scene of the traffic crash and if so, by

whom.

Enter the number 1 in the space provided if photos were taken.

Enter the number 2 in the space provided if photos were not taken.

Enter the number 1 in the space provided if the investigating agency took the photos. If not

applicable, leave blank.

Enter the number 2 in the space provided if anyone other than the investigating agency took

the photos. If not applicable, leave blank.

BY – NAME

This space is used to identify you as the investigator and your agency as the investigating law enforcement agency.

INVESTIGATOR – RANK & SIGNATURE ID/BADGE NUMBER DEPARTMENT FHP SO PD OTHER Ofc. Isaiah Hue 0312/1695 Justice Police Department X

Enter your name, rank, and signature in the space provided.

Enter your ID or badge number.

Enter the complete name of your department and place an X in the correct box.

DIAGRAM

This space is used to draw the traffic crash scene. The diagram should be prepared based on the

standard operating procedures of the submitting agency. However, at a minimum, the following

information must be documented:

Location of crash (road names).

Roadway width of each lane and roadway markings.

North directional arrow being placed upward or to the right when looking at the page.

Any physical evidence on the roadway (skid marks, ruts, holes, standing water, etc.).

Each vehicle’s position prior to, at, and post crash. This would include where the vehicle

was located at final rest upon the officer’s arrival on the scene even if the vehicle was

moved.

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FLORIDA TRAFFIC CRASH FORM

UPDATE/CONTINUATION

HSMV 90004

54

Update/Continuation

HSMV 90004

This report is used to update or upgrade information previously recorded on a Florida Traffic Crash

Report, Long Form, HSMV 90003. (This form will not be used to update information on a Short

Form but can be used to continue information from the original crash report.) This report also

functions as a continuation report to identify additional vehicle, driver, pedestrian, passenger,

property damage other than vehicles, and crash scene characteristics if more than three vehicles or

pedestrians are involved in the same traffic crash. When completing this section, it is important to

remember that code entries must correspond to the vehicle or pedestrian section they are intended to

represent and must be entered in the appropriate field(s) that are being updated. Also, all open

investigations must be updated every 30 days until the investigation is closed.

Refer to the procedures for entering data on the Long Form and Narrative/Diagram when

completing this form.

UPDATE

X FLORIDA TRAFFIC CRASH REPORT UPDATE CONTINUATION MAIL TO: DEPT. OF HIGHWAY SAFETY & MOTOR VEHICLES, TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING, TALLAHASSEE, FL 32399-0500

Provide the following information when this form is used to update a vehicle or pedestrian section.

Only the updated information and data to link the Update/Continuation report with the Long Form

and Narrative/Diagram are required.

Enter an X in the box marked “Update.”

Enter the date of the crash. The date should be identical to the date of the crash on the

Florida Traffic Crash Report, Long Form, HSMV 90003, and Narrative/Diagram, HSMV

90005 unless the date of the crash is being corrected.

Enter the county/city code. The code should be identical to county/city codes on the Florida

Traffic Crash Report, Long Form, HSMV 90003, and Narrative/Diagram, HSMV 90005

unless the county/city code is being corrected.

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Enter the investigating agency report number. The number must be identical to the

investigating agency report or file number on the Florida Traffic Crash Report, Long Form,

HSMV 90003, and Narrative/Diagram, HSMV 90005.

Enter the eight digit, pre-printed HSMV Crash Report Number. The number must be

identical to the pre-printed HSMV Crash report number on the Florida Traffic Crash Report,

Long Form, HSMV 90003, and Narrative/Diagram, HSMV 90005.

Enter the vehicle or pedestrian section number that you intend to update.

Enter the updated information. For example, alcohol/drug test results from .000 to .010.

Any information that is not updated should be left blank.

Enter rank, name, and signature of officer.


Enter the complete name of your department and place and X in the appropriate box.

Enter the page numbers starting with number 5 for the Long Form (if no Continuation form

was used in the original report) or number 7 (if a Continuation form was used in the original

report). Each time a report is updated, the sequence of the page numbers must be continued

in the proper chronological order.

SEC# PASS# PASSENGER’S NAME CURRENT ADDRESS CITY & STATE ZIP CO DATE OF BIRTH RACE SEX LOC INJ S. EQUIP. EJECT.

# PROPERTY DAMAGED – OTHER THAN VEHICLES EST. AMOUNT OWNER’S NAME ADDRESS CITY STATE ZIP $

CONTINUATION


UPDATE CONTINUATION X MAIL TO: DEPT. OF HIGHWAY SAFETY & MOTOR VEHICLES, TRAFFIC CRASH

RECORDS, NEIL KIRKMAN BUILDING, TALLAHASSEE, FL 32399-0500

Provide the following information when this form is used as a continuation report.

Enter an X in the box marked “Continuation.”

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Enter the date of the crash. The date must be identical to the date of the crash on the Florida

Traffic Crash Report, Long Form, HSMV 90003, and Narrative/Diagram, HSMV 90005.

Enter the county/city code. The code must be identical to county/city codes on the Florida

Traffic Crash Report, Long Form, HSMV 90003, and Narrative/Diagram, HSMV 90005.

Enter the investigating agency report number. The number must be identical to the

investigating agency report or file number on the Florida Traffic Crash Report, Long Form,

HSMV 90003, and Narrative/Diagram, HSMV 90005.

Enter the eight digit, pre-printed HSMV Crash Report Number. The number must be

identical to the pre-printed HSMV Crash report number on the Florida Traffic Crash Report,

Long Form, HSMV 90003, and Narrative/Diagram, HSMV 90005.

Enter the section number for the vehicle or pedestrian.

Enter additional vehicle, pedestrian, property damage other than vehicle, or passenger

information as previously outlined in this manual.

Enter rank, name, and signature of officer.


Enter the complete name of your department and place and X in the appropriate box.

Enter the page numbers starting with number 5 for the Long Form or number 7 if a

continuation form was used in the original report, and number 3 for the Short Form.

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SHORT FORM

DRIVER REPORT OF TRAFFIC CRASH

DRIVER EXCHANGE OF INFORMATION

HSMV 90006

58

Law Enforcement Short Form Report, Driver Report of

Traffic Crash, Driver Exchange of Information

HSMV 90006

This form is used as a Law Enforcement Short Form Report, Driver Report of Traffic Crash, or

Driver Exchange of Information form. Time and location data are entered based on the instructions

previously outlined for the Long Form Report. The vehicle and pedestrian sections should be

completed based on the information requested for each field. Completion of the events data (back

of Sheet 1) of the Short Form is the same as the Long Form.

The Update/Continuation form can be used with the Short Form Report only to continue

information from the original crash report and not to update it after transmittal to HSMV.

This form is used to report all traffic crashes to the department that do not require completion of a

Florida Traffic Crash Report, Long Form, HSMV 90003, by a law enforcement officer. A Short

Form Report is prepared (Sheet 1) if the officer at the scene of the traffic crash decides to report the

traffic crash to the department. The reporting officer is only required to fill in the shaded areas.

Additional data can be entered if it is required by the reporting officer’s agency.

Place an X in the box at the top of Sheet 1 that identifies the form as a Law Enforcement

Short Form Report.

Place an X in the box at the bottom of Sheet 1 that states, “No further action is required by

you. Report is completed by law enforcement agency.”

After completion, the investigating officer should distribute the remaining copies (Sheets 2, 3, and

4) to the driver(s).

If the officer decides not to report the crash, then the driver(s) must complete the form and send a

copy to the department.

The officer should remove Sheet 1 and place an X in the box at the top that identifies the

report as a Driver Report of Traffic Crash.

Place an X in the box at the bottom of Sheet 1 that states, “You must read and comply with

the instructions on the back of this page.”

Use this form as a driver exchange of information when a Long Form is completed. If this form is

not used as a driver exchange, then the officer must provide each driver and/or pedestrian with the

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other party’s driver and vehicle information. Also, this form may be used as a driver exchange of

information form when completing the Long Form Report.

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Appendix A

Glossary

61

** These definitions are per Florida State Statute 316.003. ** For other definitions not defined by Florida State Statute 316.003 please see Appendix F for other useful terms. AUTHORIZED EMERGENCY VEHICLES--Vehicles of the fire department (fire patrol), police vehicles, and such ambulances and emergency vehicles of municipal departments, public service corporations operated by private corporations, the Department of Environmental Protection, the Department of Health, and the Department of Transportation as are designated or authorized by their respective department or the chief of police of an incorporated city or any sheriff of any of the various counties BICYCLE--Every vehicle propelled solely by human power, and every motorized bicycle propelled by a combination of human power and an electric helper motor capable of propelling the vehicle at a speed of not more than 20 miles per hour on level ground upon which any person may ride, having two tandem wheels, and including any device generally recognized as a bicycle though equipped with two front or two rear wheels. The term does not include such a vehicle with a seat height of no more than 25 inches from the ground when the seat is adjusted to its highest position or a scooter or similar device. No person under the age of 16 may operate or ride upon a motorized bicycle. BICYCLE PATH--Any road, path, or way that is open to bicycle travel, which road, path, or way is physically separated from motorized vehicular traffic by an open space or by a barrier and is located either within the highway right-of-way or within an independent right-of-way. BUS--Any motor vehicle designed for carrying more than 10 passengers and used for the transportation of persons and any motor vehicle, other than a taxicab, designed and used for the transportation of persons for compensation. BUSINESS DISTRICT--The territory contiguous to, and including, a highway when 50 percent or more of the frontage thereon, for a distance of 300 feet or more, is occupied by buildings in use for business. COMMERCIAL MOTOR VEHICLE --Any self-propelled or towed vehicle used on the public highways in commerce to transport passengers or cargo, if such vehicle:

(a) Has a gross vehicle weight rating of 10,000 pounds or more; (b) Is designed to transport more than 15 passengers, including the driver; or (c) Is used in the transportation of materials found to be hazardous for the purposes of the Hazardous Materials Transportation Act, as amended (49 U.S.C. ss. 1801 et seq.).

CROSSWALK--

(a) That part of a roadway at an intersection included within the connections of the lateral lines of the sidewalks on opposite sides of the highway, measured from the curbs or, in the absence of curbs, from the edges of the traversable roadway. (b) Any portion of a roadway at an intersection or elsewhere distinctly indicated for pedestrian crossing by lines or other markings on the surface.

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DAYTIME--The period from a half hour before sunrise to a half hour after sunset. Nighttime means at any other hour. DEPARTMENT--The Department of Highway Safety and Motor Vehicles as defined in s. 20.24. Any reference herein to Department of Transportation shall be construed as referring to the Department of Transportation, defined in s. 20.23, or the appropriate division thereof. DRIVER--Any person who drives or is in actual physical control of a vehicle on a highway or who is exercising control of a vehicle or steering a vehicle being towed by a motor vehicle. ELECTRIC PERSONAL ASSISTIVE MOBILITY DEVICE--Any self-balancing, two-nontandem-wheeled device, designed to transport only one person, with an electric propulsion system with average power of 750 watts (1 horsepower), the maximum speed of which, on a paved level surface when powered solely by such a propulsion system while being ridden by an operator who weighs 170 pounds, is less than 20 miles per hour. Electric personal assistive mobility devices are not vehicles as defined in this section. FARM TRACTOR--Any motor vehicle designed and used primarily as a farm implement for drawing plows, mowing machines, and other implements of husbandry. GOLF CART--A motor vehicle designed and manufactured for operation on a golf course for sporting or recreational purposes. HAZARDOUS MATERIAL --Any substance or material which has been determined by the secretary of the United States Department of Transportation to be capable of imposing an unreasonable risk to health, safety, and property. This term includes hazardous waste as defined in s. 403.703(21). INTERSECTION --

(a) The area embraced within the prolongation or connection of the lateral curblines; or, if none, then the lateral boundary lines of the roadways of two highways which join one another at, or approximately at, right angles; or the area within which vehicles traveling upon different highways joining at any other angle may come in conflict. (b) Where a highway includes two roadways 30 feet or more apart, then every crossing of each roadway of such divided highway by an intersecting highway shall be regarded as a separate intersection. In the event such intersecting highway also includes two roadways 30 feet or more apart, then every crossing of two roadways of such highways shall be regarded as a separate intersection.

LANED HIGHWAY--A highway the roadway of which is divided into two or more clearly marked lanes for vehicular traffic. LIMITED ACCESS FACILITY--A street or highway especially designed for through traffic and over, from, or to which owners or occupants of abutting land or other persons have no right or easement, or only a limited right or easement, of access, light, air, or view by reason of the fact that their property abuts upon such limited access facility or for any other reason. Such highways or

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streets may be parkways from which trucks, buses, and other commercial vehicles are excluded; or they may be freeways open to use by all customary forms of street and highway traffic. MOPED--Any vehicle with pedals to permit propulsion by human power, having a seat or saddle for the use of the rider and designed to travel on not more than three wheels; with a motor rated not in excess of 2 brake horsepower and not capable of propelling the vehicle at a speed greater than 30 miles per hour on level ground; and with a power-drive system that functions directly or automatically without clutching or shifting gears by the operator after the drive system is engaged. If an internal combustion engine is used, the displacement may not exceed 50 cubic centimeters. MOTOR VEHICLE--Any self-propelled vehicle not operated upon rails or guideway, but not including any bicycle, motorized scooter, electric personal assistive mobility device, or moped. MOTORCYCLE--Any motor vehicle having a seat or saddle for the use of the rider and designed to travel on not more than three wheels in contact with the ground, but excluding a tractor or a moped. MOTORIZED SCOOTER--Any vehicle not having a seat or saddle for the use of the rider, designed to travel on not more than three wheels, and not capable of propelling the vehicle at a speed greater than 30 miles per hour on level ground. NONPUBLIC SECTOR BUS--Any bus which is used for the transportation of persons for compensation and which is not owned, leased, operated, or controlled by a municipal, county, or state government or a governmentally owned or managed nonprofit corporation. OFFICIAL TRAFFIC CONTROL DEVICES--All signs, signals, markings, and devices, not inconsistent with this chapter, placed or erected by authority of a public body or official having jurisdiction for the purpose of regulating, warning, or guiding traffic. OFFICIAL TRAFFIC CONTROL SIGNAL--Any device, whether manually, electrically, or mechanically operated, by which traffic is alternately directed to stop and permitted to proceed. OPERATOR--Any person who is in actual physical control of a motor vehicle upon the highway, or who is exercising control over or steering a vehicle being towed by a motor vehicle. OWNER--A person who holds the legal title of a vehicle, or, in the event a vehicle is the subject of an agreement for the conditional sale or lease thereof with the right of purchase upon performance of the conditions stated in the agreement and with an immediate right of possession vested in the conditional vendee or lessee, or in the event a mortgagor of a vehicle is entitled to possession, then such conditional vendee, or lessee, or mortgagor shall be deemed the owner, for the purposes of this chapter. PARK OR PARKING --The standing of a vehicle, whether occupied or not, otherwise than temporarily for the purpose of and while actually engaged in loading or unloading merchandise or passengers as may be permitted by law under this chapter. PEDESTRIAN--Any person afoot.

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PERSON--Any natural person, firm, co-partnership, association, or corporation. POLE TRAILER--Any vehicle without motive power designed to be drawn by another vehicle and attached to the towing vehicle by means of a reach or pole, or by being boomed or otherwise secured to the towing vehicle, and ordinarily used for transporting long or irregularly shaped loads such as poles, pipes, or structural members capable, generally, of sustaining themselves as beams between the supporting connections. POLICE OFFICER--Any officer authorized to direct or regulate traffic or to make arrests for violations of traffic regulations, including Florida highway patrol officers, sheriffs, deputy sheriffs, and municipal police officers. PRIVATE ROAD OR DRIVEWAY--Except as otherwise provided in paragraph (53)(b), any privately owned way or place used for vehicular travel by the owner and those having express or implied permission from the owner, but not by other persons. RAILROAD SIGN OR SIGNAL--Any sign, signal, or device erected by authority of a public body or official, or by a railroad, and intended to give notice of the presence of railroad tracks or the approach of a railroad train. RESIDENCE DISTRICT--The territory contiguous to, and including, a highway, not comprising a business district, when the property on such highway, for a distance of 300 feet or more, is, in the main, improved with residences or residences and buildings in use for business. RIGHT-OF-WAY--The right of one vehicle or pedestrian to proceed in a lawful manner in preference to another vehicle or pedestrian approaching under such circumstances of direction, speed, and proximity as to give rise to danger of collision unless one grants precedence to the other. ROAD TRACTOR--Any motor vehicle designed and used for drawing other vehicles and not so constructed as to carry any load thereon, either independently or as any part of the weight of a vehicle or load so drawn. ROADWAY--That portion of a highway improved, designed, or ordinarily used for vehicular travel, exclusive of the berm or shoulder. In the event a highway includes two or more separate roadways, the term "roadway" as used herein refers to any such roadway separately, but not to all such roadways collectively. SADDLE MOUNT--An arrangement whereby the front wheels of one vehicle rest in a secured position upon another vehicle. All of the wheels of the towing vehicle are upon the ground and only the rear wheels of the towed vehicle rest upon the ground. SAFETY ZONE--The area or space officially set apart within a roadway for the exclusive use of pedestrians and protected or so marked by adequate signs or authorized pavement markings as to be plainly visible at all times while set apart as a safety zone. SCHOOL BUS--Any motor vehicle that complies with the color and identification requirements of chapter 1006 and is used to transport children to or from public or private school or in connection with school activities, but not including buses operated by common carriers in urban transportation

65

of school children. The term "school" includes all preelementary, elementary, secondary, and postsecondary schools. SEMITRAILER--Any vehicle with or without motive power, other than a pole trailer, designed for carrying persons or property and for being drawn by a motor vehicle and so constructed that some part of its weight and that of its load rests upon, or is carried by, another vehicle. SIDEWALK--That portion of a street between the curbline, or the lateral line, of a roadway and the adjacent property lines, intended for use by pedestrians. SPECIAL MOBILE EQUIPMENT--Any vehicle not designed or used primarily for the transportation of persons or property and only incidentally operated or moved over a highway, including, but not limited to, ditchdigging apparatus, well-boring apparatus, and road construction and maintenance machinery, such as asphalt spreaders, bituminous mixers, bucket loaders, tractors other than truck tractors, ditchers, leveling graders, finishing machines, motor graders, road rollers, scarifiers, earthmoving carryalls and scrapers, power shovels and draglines, and self-propelled cranes and earthmoving equipment. The term does not include house trailers, dump trucks, truck-mounted transit mixers, cranes or shovels, or other vehicles designed for the transportation of persons or property to which machinery has been attached. STAND OR STANDING--The halting of a vehicle, whether occupied or not, otherwise than temporarily, for the purpose of, and while actually engaged in, receiving or discharging passengers, as may be permitted by law under this chapter. STATE ROAD--Any highway designated as a state-maintained road by the Department of Transportation. STOP--When required, complete cessation from movement. STOP OR STOPPING--When prohibited, any halting, even momentarily, of a vehicle, whether occupied or not, except when necessary to avoid conflict with other traffic or to comply with the directions of a law enforcement officer or traffic control sign or signal. STRAIGHT TRUCK--Any truck on which the cargo unit and the motive power unit are located on the same frame so as to form a single, rigid unit. STREET OR HIGHWAY--

(a) The entire width between the boundary lines of every way or place of whatever nature when any part thereof is open to the use of the public for purposes of vehicular traffic;

(b) The entire width between the boundary lines of any privately owned way or place used for vehicular travel by the owner and those having express or implied permission from the owner, but not by other persons, or any limited access road owned or controlled by a special district, whenever, by written agreement entered into under s. 316.006(2)(b) or (3)(b), a county or municipality exercises traffic control jurisdiction over said way or place; (c) Any area, such as a runway, taxiway, ramp, clear zone, or parking lot, within the boundary of any airport owned by the state, a county, a municipality, or a political subdivision, which area is used for vehicular traffic but which is not open for vehicular operation by the general public; or

66

(d) Any way or place used for vehicular traffic on a controlled access basis within a mobile home park recreation district which has been created under s. 418.30 and the recreational facilities of which district are open to the general public.

TANDEM AXLE--Any two axles whose centers are more than 40 inches but not more than 96 inches apart and are individually attached to or articulated from, or both, a common attachment to the vehicle, including a connecting mechanism designed to equalize the load between axles. TANDEM TRAILER TRUCK--Any combination of a truck tractor, semitrailer, and trailer coupled together so as to operate as a complete unit. TANDEM TRAILER TRUCK HIGHWAY NETWORK--A highway network consisting primarily of four or more lanes, including all interstate highways; highways designated by the United States Department of Transportation as elements of the National Network; and any street or highway designated by the Florida Department of Transportation for use by tandem trailer trucks, in accordance with s. 316.515, except roads on which truck traffic was specifically prohibited on January 6, 1983. THROUGH HIGHWAY--Any highway or portion thereof on which vehicular traffic is given the right-of-way and at the entrances to which vehicular traffic from intersecting highways is required to yield right-of-way to vehicles on such through highway in obedience to either a stop sign or yield sign, or otherwise in obedience to law. TRAFFIC--Pedestrians, ridden or herded animals, and vehicles, streetcars, and other conveyances either singly or together while using any street or highway for purposes of travel. TRAILER--Any vehicle with or without motive power, other than a pole trailer, designed for carrying persons or property and for being drawn by a motor vehicle. TRUCK --Any motor vehicle designed, used, or maintained primarily for the transportation of property. TRUCK TRACTOR --Any motor vehicle designed and used primarily for drawing other vehicles and not so constructed as to carry a load other than a part of the weight of the vehicle and load so drawn. VEHICLE --Every device, in, upon, or by which any person or property is or may be transported or drawn upon a highway, excepting devices used exclusively upon stationary rails or tracks. WORK ZONE AREA --The area and its approaches on any state-maintained highway, county-maintained highway, or municipal street where construction, repair, maintenance, or other street-related or highway-related work is being performed or where one or more lanes is closed to traffic.

67

Appendix B

Trailers

68

01 – Single Semi Trailer

02 – Tandem Semi Trailer

03 – Tank Trailer

69

04 – Flatbed

05 – Boat Trailer

06 – Utility Trailers

Note: A jet ski is registered as a boat and therefore is carried on a boat trailer. Jet Ski Trailer

Crashes involving a trailer carrying a jet ski should be listed as “05”.

04 – Saddle mount

70

07 – House Trailer

08 – Pole Trailer

09 – Towed Vehicle

71

10 – Auto Transport

77 – Other

77 - Cargo Trailer

77 - Concession Trailer

72

Appendix C

County Codes

73

County County Code County County Code Alachua 11 Lee 18 Baker 52 Leon 13 Bay 23 Levy 39 Bradford 45 Liberty 67 Brevard 19 Madison 35 Broward 10 Manatee 15 Calhoun 58 Marion 14 Charlotte 53 Martin 42 Citrus 47 Miami-Dade 01 Clay 48 Monroe 38 Collier 64 Nassau 41 Columbia 29 Okaloosa 43 DeSoto 34 Okeechobee 57 Dixie 54 Orange 07 Duval 2 Osceola 26 Escambia 9 Palm Beach 06 Flagler 61 Pasco 28 Franklin 59 Pinellas 04 Gadsden 21 Polk 05 Gilchrist 55 Putnam 22 Glades 60 Santa Rosa 33 Gulf 66 Sarasota 16 Hamilton 56 Seminole 17 Hardee 30 St. Johns 20 Hendry 49 St. Lucie 24 Hernando 40 Sumter 44 Highlands 27 Suwannee 31 Hillsborough 3 Taylor 37 Holmes 51 Union 63 Indian River 32 Volusia 08 Jackson 25 Wakulla 65 Jefferson 46 Walton 36 Lafayette 62 Washington 50 Lake 12 Unknown 68

74

Appendix D

City Codes

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City Name City Code City Name City Code Alachua 30 Boca Chica NAS 50 Alford 28 Boca Raton 32 Altamonte Springs 30 Bonifay 30 Altha 30 Bonita Springs 30 Anna Maria 30 Bowling Green 40 Apalachicola 30 Boynton Beach 34 Apopka 30 Bradenton 32 Arcadia 30 Bradenton Beach 34 Archer 32 Brandon 39 Astatula 28 Branford 30 Atlantic Beach 30 Brent 28 Atlantis 28 Briny Breezes 36 Auburndale 30 Bristol 30 Aventura 29 Broadview 37 Avon Park 30 Bronson 30 Azalea Park 44 Brooker 35 Bal Harbor 30 Brooksville 30 Baldwin 32 Browardale 29 Bartow 32 Browns Village 47 Bascom 52 Buena Vista 28 Bay Harbor Islands 32 Bunche Park 45 Bay Lake 31 Bunnell 30 Bayard 34 Bushnell 30 Bayshore Gardens 48 Callahan 30 Bayview 28 Calloway 30 Beacon Square 26 Canova Beach 28 Bell 44 Cantonment 30 Belle Glade 30 Cape Canaveral 30 Belle Isle 32 Cape Coral 41 Belleair 30 Carol City 37 Belleair Beach 32 Carrabelle 32 Belleair Bluffs 34 Carver Ranch Estates 39 Belleview 30 Caryville 20 Belvedere Homes 31 Casselberry 32 Bethune-Cookman College 62 Cecil Field NAS 48 Beverly Beach 28 Cedar Grove 32 Biscayne Gardens 33 Cedar Hammock/Brad. Sh. 35 Biscayne Park 34 Cedar Key 32 Blountstown 32 Center Hill 32 Boca Chica 48 Century 32

76

City Name City Code City Name City Code Chattahoochee 30 Daytona Beach Shores 32 Chiefland 34 DeBary 34 Chipley 30 Deerfield Beach 36 Cinco Bayou 28 Defuniak Springs 40 Clair-Mel 38 DeLand 36 Clearwater 36 DeLeon Springs 39 Clermont 30 Delray Beach 40 Clewiston 40 Deltona 37 Cloud Lake 38 Dept. of Agriculture 31 Cocoa 32 Destin 55 Cocoa Beach 34 Dinsmore 36 Cocoa West 49 Doctors Inlet 38 Coconut Creek 28 Doral 55 Coconut Grove 36 Dundee 36 Coleman 34 Dunedin 38 Collier Manor/Cresthaven 35 Dunnellon 32 Combee Settlement 31 E. Lake Orient Park 46 Conway 47 Eagle Lake 38 Cooper City 30 Eagle Peak 40 Coral Gables 38 East Auburndale 33 Coral Springs 31 East Naples 56 Coral Way Village 40 East Richey Lakes 34 Corry Field NAS 66 Eastpoint 31 Cottondale 30 Eatonville 34 Crawfordville 30 Eau Gallie 36 Crescent City 30 Ebro 40 Crestview 30 Eckerd College 72 Cross City 40 Edgewater 38 Cross City AF Station 45 Edgewood 35 Crystal River 40 Eglin 34 Cutler Bay 36 Eglin AFB (Okaloosa County) 62 Cutler Ridge 42 Eglin AFB (Santa Rosa County) 54 Cypress Gardens 37 Eglin AFB (Walton County) 50 Dade City 30 Egypt Lake 47 Dade County School P D 31 El Portal 44 Dania Beach 32 Ellyson Field NAS 68 Davenport 34 Englewood (Charlotte County) 52 Davie 34 Englewood (Sarasota County) 47 Daytona Beach 30 Escambia NAS 72 Daytona Beach Airport 33 Esto 32

77

City Name City Code City Name City Code Eustis 32 Golfview 26 Everglades 40 Goulds 52 Fairview Shores 36 Graceville 40 Fanning Spgs. (Gilchrist County) 46 Grand Ridge 42 Fanning Springs (Levy County) 42 Green Cove Springs 40 Fellsmere 36 Greenacres City 42 Fernandina Beach 40 Greensboro 32 Flagler Beach 40 Greenville 30 Florala 54 Gretna 34 Florida A & M University 30 Groveland 36 Florida Atlantic University 95 Gulf Breeze 40 Florida City 46 Gulf Gate Estates 38 Florida Institute of Technology 56 Gulf Stream 44 Florida International University 99 Gulfport 40 Florida Memorial College 30 Hacienda 41 Florida School for Deaf/Blind 51 Haines City 46 Florida Southern College 64 Hallendale 40 Florida State University 40 Hampton 37 Fort Lauderdale 38 Hastings 40 Fort Meade 44 Havana 40 Fort Myers 40 Haverhill 46 Fort Myers Beach 42 Hawthorne 36 Fort Myers SE 43 Hialeah 54 Fort Myers SW 46 Hialeah Gardens 56 Fort Myers Village/Pine Manor 44 High Springs 38 Fort Pierce 40 Highland Beach 48 Fort Pierce NW 30 Highland Park 31 Fort Walton Beach 32 Highland Park Village 43 Fort White 50 Hillcrest Heights 47 Franklin County 59 Hilliard 42 Freeport 52 Hillsboro Beach 42 Frostproof 42 Hobe Sound 39 Fruitland Park 34 Holden Hills 49 Gainesville 34 Holly Hill 40 Gifford 38 Hollywood 44 Glen Ridge 41 Hollywood Ridge Farm 46 Glen St. Mary 50 Holmes Beach 36 Golden Beach 48 Homestead 58 Golden Glades 50 Homestead AFB 59 Golf Village 24 Homosassa Springs 41

78

City Name City Code City Name City Code Horseshoe Beach 50 La Belle 50 Howey-in-the-Hills 38 La Crosse 39 Hypoluxo 50 Lady Lake 40 Immokalee 50 Lake Alfred 48 Indialantic 38 Lake Buena Vista 53 Indian Creek Village 60 Lake Butler 40 Indian Harbour Beach 40 Lake Carroll 48 Indian River Shores 40 Lake City 51 Indian Rocks Beach 42 Lake Clark Shores 58 Indian Shores 74 Lake Forest 47 Indiantown 40 Lake Hamilton 50 Inglis 40 Lake Helen 42 Interlachen 35 Lake Holloway 53 Inverness 42 Lake Magdalene 49 Islamorada 30 Lake Mary 38 Islandia 61 Lake Park 60 Jacksonville 38 Lake Placid 40 Jacksonville Beach 40 Lake Wales 54 Jacksonville NAS 50 Lake Worth 62 Jacksonville University 46 Lakeland 52 Jasmine Estates 32 Land O' Lakes 35 Jasper 40 Lantana 64 Jay 42 Largo 46 Jennings 42 Lauderdale by the Sea 48 Jensen Beach 41 Lauderdale Lakes 50 June Park 47 Lauderhill 52 Juno Beach 52 Laurel Hill 44 Jupiter 54 Lawtey 39 Jupiter Inlet Colony 56 Layton 44 Jupiter Island 42 Lazy Lake Village 54 Kendall 63 Lealman 47 Kennedy Space Center 64 Lee 32 Kenneth City 44 Lee Co. Airport Police 56 Kensington Park 39 Lee Field NAS 46 Key Biscayne 62 Leesburg 42 Key Colony Beach 40 Lehigh Acres 45 Key Largo 41 Leisure City 65 Key West 42 Leto 44 Keystone Heights 42 Lighthouse Point 56 Kissimmee 40 Live Oak 40

79

City Name City Code City Name City Code Lockhart 51 Miami TP 67 Longboat Key (Manatee County) 38 Micanopy 40 Longboat Key (Sarasota County) 40 Miccosukee Indian Reservation 73 Longwood 40 Middleburg 48 Lynn Haven 34 Midway 45 Macclenny 60 Milton 50 MacDill AFB 58 Mims 41 Maderia Beach 48 Minneola 52 Madison 40 Miramar 62 Maitland 40 Monticello 40 Malabar 60 Montverde 53 Malone 46 Moore Haven 40 Manalapan 66 Mount Dora (Lake County) 54 Mandarin 42 Mount Dora (Orange County) 39 Mangonia Park 68 Mulberry 56 Marathon 45 Munson Island 46 Margate 60 Myrtle Grove 40 Marianna 50 Naples 52 Marineland 42 Naranja 74 Mary Esther 40 Neptune Beach 44 Mascotte 50 New Port Richey 40 Mayo 40 New Smyrna Beach 44 Mayport NAS 52 Newberry 42 McCoy AFB 56 Niceville 42 McIntosh 34 Nokomis/Laurel 41 Medley 64 North Andrews Garden 67 Melbourne 42 North Bay 76 Melbourne AA 66 North Bay Village 78 Melbourne Beach 44 North Fort Myers 47 Melbourne Village 65 North Lauderdale 63 Melrose Park 61 North Miami 80 Memphis 44 North Miami Beach 82 Merritt Island 45 North Naples 54 Mexico Beach 40 North Palm Beach 70 Miami 66 North Port 48 Miami Beach 68 North Redington Beach 50 Miami Gardens 57 Norwood 71 Miami Lakes 69 Oak Hill 46 Miami Shores 70 Oakland 41 Miami Springs 72 Oakland Park 64

80

City Name City Code City Name City Code Ocala 40 Palmetto Estates 79 Ocean Breeze Park 50 Panama City 50 Ocean City 36 Panama City Beach 62 Ocean Ridge 72 Parker 51 Ocean Ridge Park 52 Parkland 71 Ocoee 42 Parrish 43 Ojus 83 Patrick AFB 48 Okaloosa County Airprt 33 Paxton 60 Okeechobee 50 Pembroke Park 66 Oldsmar 52 Pembroke Pines 68 Olympia Heights 77 Penny Farms 47 Oneco 40 Pensacola 50 Opa Locka 84 Perrine 85 Orange City 48 Perry 50 Orange Park 44 Pierson 52 Orchid 42 Pine Crest Village 35 Orlando 46 Pine Hills 48 Orlando AFB 58 Pinellas Co Campus P D 78 Orlando TP 57 Pinellas Park 54 Orlando Transit Authority 33 Pinewood 81 Orlovista 43 Plant City 40 Ormond Beach 50 Plantation 70 Ormond By The Sea 41 Plantation Key 43 Otter Creek 41 Polk City 60 Oviedo 44 Pompano Beach 72 Pahokee 74 Pompano Beach Hlnds 65 Painter Hill 44 Ponce De Leon 40 Palatka 40 Ponce Inlet 54 Palm Bay 46 Ponte Vedra 46 Palm Beach 76 Port Charlotte (Charlotte County) 54 Palm Beach AFB 75 Port Charlotte (Sarasota County) 42 Palm Beach Gardens 78 Port Orange 56 Palm Beach School Bd. 96 Port Richey 50 Palm Beach Shores 80 Port Salerno 54 Palm City 53 Port St. Joe 40 Palm River/Clair Mel 51 Port St. Lucie (Martin County) 56 Palm Shores 62 Port St. Lucie (St. Lucie County) 50 Palm Springs 82 Port Washington 62 Palmetto 42 Progress Village 42 Palmetto Bay 51 Punta Gorda 50

81

City Name City Code City Name City Code Quincy 50 Sneads 51 Raiford 41 Sopchoppy 60 Reddick 42 South Bay 88 Redington Beach 56 South Daytona 60 Redington Shores 58 South Miami 87 Richmond Heights 86 South Miami Heights 95 Ridgewood Heights 52 South Palm Beach 90 Riveria Beach 84 South Pasadena 62 Riverland 69 South Patrick Shores 51 Rockledge 50 South Peninsula 61 Rocky Creek 43 Springfield 52 Royal Palm Beach 86 St. Augustine 50 Ruskin 45 St. Augustine Beach 52 Safety Harbor 60 St. Cloud 50 Samoset 46 St. Leo 62 San Antonio 60 St. Lucie Village 52 Sanford 60 St. Marks 62 Sanibel 50 St. Pete/Clearwater Airport 65 Santa Rosa Beach 42 St. Petersburg 64 Sante Fe Community College 31 St. Petersburg Beach 66 Sarasota 50 Starke 40 Sarasota S 43 Steinhatchee 40 Sarasota SE 49 Stetson University 64 Sarasota Springs 44 Stuart 62 Sarasota-Manatee Air 51 Sunny Isles 88 Satellite Beach 52 Sunrise 76 Saufley Field NAS 70 Surfside 89 Sea Ranch Lakes 74 Sweetwater 90 Sebastian 50 Sweetwater Creek 41 Sebring 50 Tallahassee 50 Sebring Airport 51 Tamarac 77 Seminole 76 Tampa 50 Seminole Indian Reservation 75 Tampa International Airport 60 Seminole Park 61 Tarpon Springs 68 Seville 58 Tavares 60 Sewalls Point 60 Tavernier 52 Shalimar 46 Temple Terrace 52 Siesta Key 45 Tequesta Village 92 Silver Springs Shore 50 Tice 55 Sky Lake 45 Titusville 54

82

City Name City Code City Name City Code Treasure Island 70 West Hollywood 78 Trenton 50 West Melbourne 43 Tyndall AFB 60 West Miami 93 Uleta 96 West Palm Beach 94 Umatilla 62 West Pensacola 63 Unincorporated 0 West Winter Haven 55 Unincorporated Count 91 Weston 79 Union Park 70 Westview 98 Univ. of Central Florida 55 Westville 36 Univ. of Florida 50 Westwood Lakes 97 Univ. of Miami 94 Wewahitchka 52 Univ. of North Florida 60 White Springs 60 Univ. of South Florida 54 Whiting Field 52 Univ. of Tampa 56 Wildwood 62 Univ. of West Florida 64 Williston 60 Valparaiso 60 Wilton Manors 80 Venice 60 Windermere 50 Venice South 46 Winston 35 Vernon 50 Winter Garden 52 Vero Beach 52 Winter Haven 62 Vero Beach South 54 Winter Park 54 Village of Pinecrest 35 Winter Springs 70 Virginia Gardens 92 Worthing Springs 50 Wabasso 60 Yankeetown 62 Wahneta 61 Yulee 60 Wakulla 64 Zephyrhills 70 Waldo 60 Zolfo Springs 80 Ward Ridge 50 Warrington 62 Watertown 49 Wauchula 60 Wausua 60 Webster 60 Weekiwachee 40 Welaka 60 Wellington 89 West Bradenton 50 West Eau Gallie 53 West End 39 West Gate 93

83

Appendix E

State Codes

84

State Abbrev. State Name Country AG AGUASCALIENTES M AL ALABAMA U AK ALASKA U AB ALBERTA C AS AMERICAN SAMOA O AZ ARIZONA U AR ARKANSAS U BN BAJA CALIFORNIA NORTE M BS BAJA CALIFORNIA SUR M BZ BELIZE O BC BRITISH COLUMBIA C CA CALIFORNIA U CP CAMPECHE M CZ CANAL ZONE M CS CHIAPAS M CI CHIHUAHUA M CH COAHUILA M CL COLIMA M CO COLORADO U CT CONNECTICUT U CR COSTA RICA O DE DELAWARE U DC DISTRICT OF COLUMBIA U DF DISTRITO FEDERAL M DG DURANGO M ES EL SALVADOR O FL FLORIDA U GA GEORGIA U GU GUAM U GJ GUANAJUATO M GT GUATEMALA O GE GUERRERO M HI HAWAII U HD HIDALGO M HO HONDURAS O ID IDAHO U IL ILLINOIS U IN INDIANA U IA IOWA U JA JALISCO M KS KANSAS U KY KENTUCKY U LA LOUISIANA U ME MAINE U MB MANITOBA C

85

MD MARYLAND U MA MASSACHUSETTS U MX MEXICO M MI MICHIGAN U MC MICHOACAN M MN MINNESOTA U MS MISSISSIPPI U MO MISSOURI U MT MONTANA U MR MORELOS M NA NAYARIT M NE NEBRASKA U NV NEVADA U NB NEW BRUNSWICK C NH NEW HAMPSHIRE U NJ NEW JERSEY U NM NEW MEXICO U NY NEW YORK U NF NEWFOUNDLAND C NI NICARAGUA O NC NORTH CAROLINA U ND NORTH DAKOTA U NT NORTHWEST TERRITORIES C NS NOVA SCOTIA C NL NUEVO LEON M OA OAXACE M OH OHIO U OK OKLAHOMA U ON ONTARIO C OR OREGON U OT OTHER O PN PANAMA O PA PENNSYLVANIA U PE PRINCE EDWARD C PU PUEBLA M PR PUERTO RICO U PQ QUEBEC C QE QUERETARO M QI QUINTANA ROO M RI RHODE ISLAND U SL SAN LUIS POTOSI M SK SASKATCHEWAN C SI SINALOA M SO SONORA M SC SOUTH CAROLINA U SD SOUTH DAKOTA U TB TABASCO M TA TAMAULIBAS M

86

TN TENNESSEE U TX TEXAS U TL TLAXCALA M UK UNKNOWN O UT UTAH U VC VERACRUZ M VT VERMONT U VI VIRGIN ISLANDS U VA VIRGINIA U WA WASHINGTON U WV WEST VIRGINIA U WI WISCONSIN U WY WYOMING U YU YUCATAN M YT YUKON TERRITORY C ZA ZACATECAS M

87

Appendix F

Other Useful Terms

88

** These terms are per the National Highway Traffic Safety Administration ** AIR BAG DEPLOYED -- Deployment status of an air bag relative to position of the occupant. ALCOHOL -- The percent of alcohol concentration. ALCOHOL/DRUG INVOLVEMENT -- Investigating police officer’s assessment of whether alcohol or drug use was suspected or demonstrated to be present by test for any vehicle driver or non-motorist in the crash. ALCOHOL/DRUG SUSPECTED -- Investigating police officer’s assessment of whether alcohol or drugs were used by the vehicle driver or non-motorist. ANGLE - MANNER OF IMPACT -- A crash where two vehicles impact at an angle. For example, the left front of one vehicle impacts the side of another vehicle. ANIMAL -- Creatures which have the capacity for movement and motor response to stimulation but are not human beings. APPROACHING OR LEAVING VEHICLE -- Physical movement in the direction of or in the direction away from the vehicle. AT INTERSECTION BUT NO CROSSWALK -- At an area which contains a crossing or connection of two or more roadways not classified as a driveway access but without the street crossing distinctly indicated for pedestrian crossing by lines or other markings on the surface of the roadway. AUTO TRANSPORTER -- A single-unit truck, truck/trailer, or tractor/semi-trailer having a cargo body specifically designed to transport other motor vehicles. BACKING -- A start from a parked or stopped position in the direction of the rear of the vehicle. BARRIER -- A device which provides a physical limitation through which a vehicle would not normally pass and is designed to contain or redirect an errant vehicle. BRIDGE -- A structure, including supports, carrying a roadway, railroad, etc. over an obstruction such as water, a railway, or another roadway, having an opening of 20 feet or more measured along the center of the structure. BRIDGE - OVERHEAD STRUCTURE -- Any part of a bridge that is over the reference or subject roadway. In crash reporting, this typically refers to the beams or other structural elements supporting a bridge deck. BRIDGE - PIER OR ABUTMENT -- A bridge pier is a support for a bridge structure other than at the ends. A bridge abutment is the end support for a bridge. BRIDGE – RAIL -- A barrier attached to a bridge deck or a bridge parapet to restrain vehicles, pedestrians or other users.

89

CARGO BODY TYPE -- Coded for buses and trucks over 10,000 pounds GVWR. CARGO/LOSS OR SHIFT -- The release of the goods being transported from the cargo compartment of the truck, or the change in the position of the goods within the cargo compartment. CARGO RELEASED -- The goods being transported by truck spilled out of the vehicle cargo compartment. CARGO TANK -- A single-unit truck, truck/trailer, or tractor/semi-trailer having a cargo body designed to transport either dry bulk (fly ash, etc.), liquid bulk (gasoline, milk, etc.), or gas bulk (propane, etc.). CARRIER IDENTIFICATION NUMBER -- A unique number, found on the power unit, and assigned by the U.S. Department of Transportation, Interstate Commerce Commission, or by the state to a motor carrier. CARRIER NAME -- The name of an individual, partnership, or corporation responsible for the transportation of persons or property. CARRIER NAME SOURCE -- Where the name of the motor carrier was noted, be it the power unit of the truck, the trailer, the shipping papers, or other documents. CARRIER STREET ADDRESS -- The street address of the carrier. CHANGING LANES -- A vehicle shift from one traffic lane to another traffic lane moving in the same direction. CHILD SAFETY SEAT USED -- Child passenger was seated in a child safety seat. This does not imply correct use or placement of the child safety seat. CITED -- Receipt of a motor vehicle citation for actions as a result of a motor vehicle crash. CLEAR -- Free from clouds, fog, smoke. CLOUDY -- Overcast with clouds. (Cloud - a visible mass of particles of water or ice in the form of fog, mist, or haze suspended usually at a considerable height in the air.) COLLISION -- A vehicle crash in which the first harmful event is a collision of a vehicle in transport with another vehicle, other property, animal or pedestrian. COLLISION WITH FIXED OBJECT -- A collision crash in which the first harmful event is the striking of a fixed object by a vehicle in transport. COLLISION WITH OBJECT NOT FIXED -- A collision crash in which the first harmful event is the striking by a vehicle in transport of an object that is not fixed.

90

CONCRETE MIXER -- A single-unit truck with a body specifically designed to mix or agitate concrete. CONSTRUCTION ZONE -- See Work Zone. CONTRIBUTING CIRCUMSTANCES, DRIVER -- The actions of the driver which may have contributed to the crash. CONTRIBUTING CIRCUMSTANCES, ENVIRONMENT -- Apparent environmental conditions which contributed to the crash. CONTRIBUTING CIRCUMSTANCES, NON-MOTORIST -- The actions of the non-motorist which may have contributed to the crash. CONTRIBUTING CIRCUMSTANCES, ROAD -- Apparent condition of the road which contributed to the crash. CRASH CITY/PLACE -- The city/place in which the crash occurred. CRASH COUNTY -- The county in which the crash occurred. CRASH DATE AND TIME -- The date (year, month, and day) and time (hour and minute) at which the crash occurred. CRASH ROADWAY LOCATION -- Exact location on the roadway indicating where the crash occurred. CRASH SEVERITY -- The severity of a crash based on the most severe injury to any person involved in the crash. CROSSOVER -- Area in the median of a divided roadway where vehicles are permitted to travel cross the opposing lanes of traffic or do a U-turn. CULVERT -- An enclosed structure providing free passage of water under a roadway with a clear opening of 20 feet or less measured along the center of the roadway. CURB -- A raised edge or border to a roadway. Curbs may be constructed of concrete, asphalt, or wood and typically have a face height of less than 9 inches. DARK - LIGHTED ROADWAY -- It is dark but the roadway is lighted by lights designed and installed to illuminate the roadway. This is not lighting from store front, house lamps, etc. DARK - ROADWAY NOT LIGHTED -- It is dark and the roadway is not lighted by lights designed and installed to illuminate the roadway. DARK - UNKNOWN ROADWAY LIGHTING -- It is dark and it is unknown if the roadway was lighted by lights designed and installed to illuminate the roadway.

91

DART OUT -- Pedestrian enters street quickly and is struck by or walks or runs into a moving vehicle. DATE AND TIME CRASH REPORTED TO POLICE AGENCY -- The date and time at which the call was placed notifying the police agency about the crash. DATE OF BIRTH --Year, month, and day of birth of person involved in crash. DAWN -- The first appearance of light in the morning. DAYLIGHT -- The light of day. DEBRIS -- The remains of something broken or destroyed. DEPLOYED AIR BAG-DRIVER -- Driver air bag out of its cover and protruding into driver compartment. Bag is fully or partially deflated or inflated. DEPLOYED AIR BAG-FRONT SEAT PASSENGER -- Front seat passenger air bag out of its cover and protruding into front seat passenger compartment. Bag is fully or partially deflated or inflated. DEPLOYED SIDE AIR BAG -- Air bag on side of vehicle is out of its cover and protruding into occupant compartment. Bag is fully or partially deflated or inflated. DEPLOYMENT OF AIR BAG -- Air bag out of its cover and protruding into occupant compartment. Bag is fully or partially deflated or inflated. DEPLOYMENT OF AIR BAG UNKNOWN -- Not known if air bag is out of its cover and protruding into occupant compartment. DIRECTION OF TRAVEL BEFORE CRASH -- The direction of a vehicle’s normal, general travel on the roadway before the crash. Notice that this is not a compass direction but a direction consistent with the designated direction of the road. For example, the direction of a state designated north-south highway must be either northbound or southbound even though a vehicle may have been traveling due east as a result of a short segment of the highway having an east-west orientation. DISABLING DAMAGE -- Damage which precludes departure of the vehicle from the scene of the crash in its usual operating manner after simple repairs. DISREGARDED TRAFFIC SIGNS, SIGNALS, ROAD MARKINGS -- Driver failed to comply with the instructions directed by traffic signs, signals, or road markings. DITCH -- Channel dug into the ground. DOWNHILL RUNAWAY -- A motor vehicle that is moving down a hill without the ability to stop.

92

DRIVER -- An occupant who is in actual physical control of a vehicle or, for an out-of-control vehicle, an occupant who was in control until control was lost. DRIVER CONDITION -- The condition of the driver which may have contributed to the crash. DRIVER DISTRACTED -- Determination that occupant who is in actual physical control of a vehicle had his/her attention diverted from driving. DRIVER LICENSE CLASS -- The type of commercial or noncommercial vehicle that a licensed driver has been examined on and/or approved to operate. DRIVER LICENSE NUMBER -- A unique number assigned by the authorizing agent issuing a driver license to the individual. DRIVER LICENSE RESTRICTIONS -- Restrictions assigned to an individual’s driver license by the license examiner. DRIVER LICENSE STATE/PROVINCE -- The geographic or political entity issuing a driver license. DRIVER LICENSE STATUS -- The current status of an individual’s driver license. DRIVER NAME -- The full name of the individual driver. DRIVEWAY -- A roadway providing access to property adjacent to a trafficway. DRIVEWAY ACCESS CROSSWALK -- Crosswalk on roadway providing access to property adjacent to a trafficway. DRIVING TOO FAST FOR CONDITIONS -- Traveling at a speed that was unsafe for the road, weather, traffic or other environmental conditions at the time. DRUGS -- Indication of the presence of drugs through drug testing. DRY -- Free from water or liquid. DUMP TRUCK -- A truck which can be tilted or otherwise manipulated to discharge its load by gravity. DUSK -- The darker part of twilight at night. EJECTION -- The location of each occupant’s body as being completely or partially thrown from the vehicle as a result of a crash. EMBANKMENT -- A structure of soil or rock above the original ground upon which a structure is constructed.

93

EMERGENCY USE -- Indicates vehicles, such as military, police, ambulance, fire, etc., which are on an emergency response. Emergency refers to a vehicle that is traveling with physical emergency signals in use, siren sounding, etc. ENTERING OR CROSSING SPECIFIED LOCATION -- Non-occupant went into or crossed over a specific identified area that either was or was not part of the trafficway or roadway. ENTERING TRAFFIC LANE -- Physical presence in trafficway. EXCEEDED AUTHORIZED SPEED LIMIT -- Driver was operating vehicle faster than posted speed limit at time of crash. FAILURE TO KEEP IN PROPER LANE OR RUNNING OFF ROAD -- Driver did not maintain position in appropriate travel lane or moved off that part of a trafficway which includes both the roadway and any shoulder alongside the roadway. FAILURE TO OBEY TRAFFIC SIGNS, SIGNALS, OR OFFICER -- Non-motorist did not comply with the instructions directed by traffic signs, signals, or a police officer at the scene. FAILED TO YIELD RIGHT OF WAY -- Driver did not give way to another vehicle or non-occupant as required. FATAL INJURY -- Any injury that results in death within a 30 day period after the crash occurred. FIRE/EXPLOSION -- Fire/explosion which was the cause or product of the crash. FIRST EVENT -- Occurrence which was the first thing that happened to the vehicle, relevant to the crash. FIRST HARMFUL EVENT -- The injury or damage producing event which characterizes the crash type and identifies the nature of the first harmful event. FLATBED -- A single-unit truck, truck/trailer, or tractor/semi-trailer whose body is without sides or roof, with or without readily removable stakes which may be tied together with chains, slats, or panels. FOG, SMOG, SMOKE -- Fog - a vapor condensed to fine particles of water suspended in the lower atmosphere that differs from cloud only in being near the ground. Smog - a fog made heavier and darker by smoke and chemical fumes. Smoke - the suspension of solid particles of combustion in the atmosphere. FOLLOWED TOO CLOSELY -- Driver was positioned too near another vehicle or non-occupant to permit safe response to any change in movement or behavior of the other vehicle or non-occupant. FRONT SEAT - LEFT SIDE -- Driver seat for motor vehicle or motorcycle. FRONT SEAT - RIGHT SIDE -- Passenger seat to right of driver and next to the door.

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FRONT SEAT - MIDDLE -- Passenger seat between driver and right seat passenger. FUNCTIONAL DAMAGE -- Damage which is not disabling, but affects operation of the vehicle or its parts. GLARE -- A harsh uncomfortably bright light. GRADE -- The inclination of a roadway, expressed in the rate of rise or fall in feet per 100 feet of horizontal distance. GRAIN/CHIPS/GRAVEL TRUCK -- Truck with closed sides and bottom to carry grain, chips, gravel, etc. GROSS VEHICLE WEIGHT RATING OF POWER UNIT -- A gross vehicle weight rating (GVWR) is a value specified by the manufacturer for the power unit of a motor vehicle. GUARDRAIL -- A longitudinal barrier consisting of posts and rails or cables. HAZARDOUS MATERIALS -- Any substance or material which has been determined by the U.S. Secretary of Transportation to be capable of posing an unreasonable risk to health, safety, and property when transported in commerce and which has been so designed under regulations of the US DOT. HAZARDOUS MATERIALS PLACARD (CARGO ONLY) -- A diamond shaped sign that must be affixed to any motor vehicle that carries hazardous materials usually contains a four digit number in the middle of the placard and a one digit number at the bottom that indicate the hazard class and specific material being carried. HAZARDOUS MATERIALS RELEASED INVOLVEMENT (CARGO ONLY) -- Indication whether hazardous materials were released from the cargo compartment. HEAD-ON - MANNER OF IMPACT -- A crash where the front end of two vehicles impact. HELMET USED -- Safety helmet was worn by non-motorist or driver. HIGHWAY, STREET OR ROAD -- A general term denoting a public way for purpose of vehicular travel, including the entire area within the right-of-way. HIGHWAY TRAFFIC SIGN POST -- A pole, post, or structure constructed to support a highway sign intended to guide, regulate, or inform highway users. HOLES -- An opening in the road. IMPACT ATTENTUATOR/CRASH CUSHION -- A barrier at a spot location, less than 25 feet, designed to prevent an errant vehicle from impacting a fixed object hazard by gradually decelerating the vehicle to a safe stop or by redirecting the vehicle away from the hazard.

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IMPROPER ACTION -- Action contrary to motor vehicle rules. IMPROPER CROSSING -- Crossing a trafficway against the rules. IN ROADWAY -- Physically located in that part of trafficway designed, improved, and ordinarily used for motor vehicle travel. INJURY DESCRIPTION -- Type of injury. INTERSECTION TYPE -- The type of intersection at which two or more roadways intersect at the same level. JACKKNIFE -- An event involving a truck pulling a semi-trailer or semi-trailers and trailers where the trailing unit(s) and the pulling vehicle rotate with respect to each other. LANE -- A strip of roadway used for a single line of vehicles. LANE LINE -- A pavement marking used to separate traffic traveling in the same direction. Lane lines are normally 4 to 6 inches wide. LAP BELT ONLY USED -- Use of or presence of only a lap safety belt either because vehicle is equipped only with lap belt or because shoulder belt is not in use. LIGHT TRUCK WITH ONLY FOUR TIRES -- Trucks (van, mini-van, panel, pickup, sport utility) of 10,000 pounds gross vehicle weight rating or less. LIGHTING -- Non-motorist use of lights on his/her person or on a vehicle not in transport or transport vehicles other than motor vehicle as safety equipment. LOGBOOK -- A document carried in the truck cab or bus in which commercial motor vehicle drivers must enter their record of duty status for each 24 hour period using methods proscribed by the US DOT. LYING/ILLEGALLY IN ROADWAY -- Person physically located in that part of trafficway designed, improved, and ordinarily used for motor vehicle travel. MADE IMPROPER TURN -- Driver turned vehicle incorrectly or not suitably to the circumstances. MAINTENANCE ZONE -- See Work Zone. MARKED CROSSWALK AT INTERSECTION -- That portion of the roadway at the intersection that is distinctly indicated for pedestrian crossing by lines or other markings on the surface of the roadway. MEDIAN -- The portion of a divided highway separating the traveled way for traffic in opposing directions.

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MOST HARMFUL EVENT FOR THIS VEHICLE -- Event which produced the most severe injury or greatest property damage for this vehicle. MOTOR HOME -- A van where a frame-mounted recreational unit is added behind the driver or cab area or mounted on a bus/truck chassis. MOTOR VEHICLE IN TRANSPORT -- Motor vehicle - any motorized (mechanically or electrically powered) road vehicle not operated on rails. In Transport - means in motion or on a roadway. Inclusions: motor vehicle in traffic on a highway, driverless motor vehicle in motion, motionless motor vehicle abandoned on a roadway, disable motor vehicle on a roadway, etc. MOTORCYCLE -- A two- or three-wheeled motor vehicle designed to transport one or two people. MOTORIST -- Any occupant of a motor vehicle in transport. NO ACCESS CONTROL -- Includes all sections that do not meet the criteria for full or partial access control. NO IMPROPER DRIVING -- Driver operated vehicle in an apparently correct manner. NON-FATAL INJURY -- Bodily harm to a person. NON-HIGHWAY WORK -- Work on the roadside but not related to the roadway. For example, workers mowing the roadside, utility workers working on utility poles adjacent to roadway. NON-INTERSECTION CROSSWALK -- A portion of the roadway, not at an intersection, that is distinctly indicated for pedestrian crossing by lines or other markings on the surface of the roadway. NON-MOTORIST -- Any person other than an occupant of a motor vehicle in transport. This includes pedestrians, occupants of other motor vehicles not in transport and occupants of transport vehicles other than motor vehicles. NON-MOTORIST ACTION -- The actions of the non-motorist prior to the crash. NON-MOTORIST LOCATION PRIOR TO IMPACT -- The non-motorist’s location with respect to the roadway prior to impact. NON-MOTORIST SAFETY EQUIPMENT -- The safety equipment(s) used by the non-motorist, including retro-reflective clothing, lighting, protective pads, helmet, etc. OBSTRUCTION IN ROADWAY -- A blockage in roadway. OCCUPANT PROTECTION SYSTEM USE -- The restraint equipment in use by occupant at the time of the crash, or the helmet use by a motorcyclist. OFF RAMP -- An auxiliary roadway used for leaving through-traffic lanes.

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ON RAMP -- An auxiliary roadway used for entering through-traffic lanes. OPERATING DEFECTIVE EQUIPMENT (DRIVER) -- Vehicle in transport or any part or component of vehicle in transport is deficient, faulty, incomplete or incapacitated. OPERATING VEHICLE IN ERRATIC, RECKLESS, CARELESS, NEGLIGENT OR AGGRESSIVE MANNER -- Operating the vehicle without regard to the safety of occupants, non-occupants or property. OTHER NON-FIXED OBJECT - COLLISION WITH -- A collision with an object other than a motor vehicle in transit, a pedestrian, an other road vehicle in transit, a parked motor vehicle, a railway vehicle, a pedalcycle, an animal, or a fixed object. OVERCORRECTING/OVERSTEERING -- Wide swing of vehicle to right or left because of sliding, etc. or to compensate for obstacle in roadway. OVERHEAD SIGN SUPPORT -- A pole, post, or structure constructed to support a sign which is over a roadway. OVERTAKING/PASSING -- A vehicle that moves from behind a vehicle to in front of the same vehicle. OVERTURN/ROLLOVER -- A vehicle that has overturned at least 90 degrees to its side. PARKED MOTOR VEHICLE -- A motor vehicle not in transport. PARTIALLY EJECTED -- The location of an occupant’s body not completely thrown from the vehicle as a result of a crash. PASSENGER -- Occupant of vehicle other than the driver of the vehicle. PAVEMENT MARKINGS -- Markings set into the surface of, applied upon, or attached to the pavement for the purpose of regulating, warning, or guiding traffic. Markings are typically paint or plastic but may be devices of various materials. PEDALCYCLIST -- Any occupant of a pedalcycle (bicycle, tricycle, unicycle, pedal car). PEDESTRIAN -- Any person on foot on a roadway. PHYSICAL IMPAIRMENT -- A condition that results in some decrease in a physical ability. PHYSICAL OBSTRUCTION - CONTRIBUTING CIRCUMSTANCES -- An object which blocked sight and contributed to the crash. (For example, bush, tree, etc.) PLACARD NUMBER -- A number included on the hazardous material placard displayed on trucks that are carrying hazardous materials. Many placards have two numbers, a four-digit number in the middle, and a one digit number at the bottom.

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PLAYING OR WORKING ON VEHICLE -- Non-motorist touching vehicle. POINT OF IMPACT -- The portion of the vehicle that impacted first in a crash. POLE TRAILER -- A trailer designed to be attached to the towing vehicle by means of a reach or pole, or by being boomed or otherwise secured to the towing road vehicle, and ordinarily used for carrying property of a long or irregular shape. PROPERTY DAMAGE ONLY -- Crash in which at least one vehicle is damaged but no occupants or non-motorists are injured. RAILWAY CROSSING DEVICE -- Any sign, signal, or gate which warns of on-coming trains or train tracks crossing the roadway. RAILWAY GRADE CROSSING -- A intersection between a roadway and train tracks which cross each other at the same level (Grade). RAILWAY VEHICLE -- Any land vehicle (e.g., train, engine) that is (1) designed primarily for, or in use for, moving persons or property from one place to another on rails and (2) not in use on a land way other than a railway. RAILWAY VEHICLE – COLLISION WITH -- A collision crash in which the first harmful event is the collision of a road vehicle in transport and railway vehicle (e.g., train, engine). RAISED PAVEMENT MARKER -- An individual unit marker, reflectorized or nonreflectorized, generally less than one-inch in height, attached to and extending above the normal pavement surface for the purpose of regulating, warning, or guiding traffic. RAN OFF ROAD -- Failure of the driver to keep the vehicle within the roadway traffic lanes. REAR-END - MANNER OF IMPACT -- A crash where the front of one vehicle impacts the back of another vehicle. RELATION TO ROADWAY -- The location of the first harmful event as it relates to its position within or outside the trafficway. RIDING ON VEHICLE EXTERIOR -- Person outside of vehicle (on hood, running board, trunk, non-trailing unit, etc.) while riding. ROAD SURFACE CONDITION -- The roadway surface condition at the time and place of a crash. ROAD UNDER CONSTRUCTION/MAINTENANCE -- Roadway being constructed or resurfaced. ROADSIDE -- The outermost part of the trafficway from the property line to other boundary in to the edge of the first road.

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ROADWAY -- That part of a trafficway designed, improved, and ordinary used for motor vehicle travel or, where various classes of motor vehicle are segregated, that part of a trafficway used by a particular class. Separate roadways may be provided for northbound and southbound traffic or for trucks and automobiles. Bridle paths and bicycle paths are not included in this definition. ROADWAY - CRASH ON -- (1) a collision crash in which the initial point of contact between colliding units in the first harmful event is within a roadway or (2) a non-collision crash in which the road vehicle involved was partly or entirely on the roadway at the time of the first harmful event. ROADWAY LIGHTING -- The type of roadway illumination on the roadway. ROADWAY SURFACE CONDITION -- The roadway surface conditions at the time and place of a crash. RUT -- Track worn by wheel or by habitual passage in the road. SAND, MUD, DIRT, OIL, GRAVEL -- Sand - loose granular material resulting from the disintegration of rock on the road. Mud - slimy sticky mixture of soil and water on the road. Dirt - loosed or packed soil on the road. Oil - substance that is liquid and soluble in ether but not in water. Gravel – loose rounded fragments of rock on the road. SCHOOL BUS -- A motor vehicle used for the transportation of any school pupil at or below the 12th-grade level to or from a public or private school or school-related activity, if it is externally identifiable by the color yellow, the words “school bus”, flashing red lights are located on the front and rear, and identifying lettering on both sides indicating the school or school district served, or the company operating the bus. SCHOOL ZONE SIGNS -- Signs which change the speed limit on road adjacent to schools on school days, signs which give advance warning of school and signs which warn of children crossing the road. SEATING POSITION -- Location of occupant in, on, or outside of the motor vehicle prior to the impact of a crash. SECOND EVENT -- Occurrence which was the second thing that happened to the vehicle in question that was relevant to the crash. SEPARATION OF UNITS -- When the truck or truck tractor becomes separated from the semi-trailer and/or trailer(s) they are pulling. SEQUENCE OF EVENTS -- The events in sequence for this vehicle. SHIPPING PAPERS (TRUCK) -- The documents carried in the cab of the truck or truck tractor that indicates the cargo being carried and other motor carrier responsible for the movement of the cargo.

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SHOULDER -- That part of a trafficway contiguous with the roadway for emergency use, for accommodation of stopped road vehicles, and for lateral support of the roadway structure. SHOULDER AND LAP BELT USED -- In a two part occupant restraint system, both the shoulder belt and lap belt portions are connected to a buckle. SHOULDER BELT ONLY USED -- In a two part occupant restraint system, only the shoulder belt portion is connected to a buckle. SHOULDERS LOW, SOFT, OR HIGH -- A shoulder with a different height than that of the roadway. SIDESWIPE, SAME DIRECTION - MANNER OF IMPACT -- A crash where two vehicles traveling the same direction and impact on the side. SIDESWIPE, OPPOSITE DIRECTION - MANNER OF IMPACT -- A crash where two vehicles traveling the opposite direction and impact on the side. SIDEWALK -- The portion of a highway, other than the roadway, set apart by curbs, barriers, markings or other delineation for exclusive use by pedestrians. SINGLE-UNIT TRUCK (3-OR-MORE AXLES) -- A power unit that includes a permanently mounted cargo body (also called a straight truck) that has three or more axles. SINGLE-UNIT TRUCK (2-AXLE, 6- TIRE) -- A power unit that includes a permanently mounted cargo body (also called a straight truck) that has only two axles and at least six tires on the ground. SLOPE -- The change in the elevation of an element of the roadway per unit of horizontal length, may be expressed as a percent or a ratio. STANDING -- Non-motorist not in movement on the roadway. STOPPED IN TRAFFIC -- Vehicle stopped in traffic at the time of the crash. SWERVING OR AVOIDING DUE TO WIND, SLIPPERY SURFACE, VEHICLE, OBJECT, NON-MOTORIST IN ROADWAY, ETC. -- Defensive driver action to defend against an apparent danger in, on, or due to the condition of the roadway or the presence of vehicle or object or non-motorist in the roadway in order to avoid a crash. TEST GIVEN, RESULTS UNKNOWN -- Person administered test for drug/alcohol presence, but outcome of test not known. TEST REFUSED -- Person refused to take drug/alcohol test. TEST RESULT -- Outcome of test for drug presence indicating, if drugs present, which type is present.

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THROUGH TRAVELED WAY -- The portion of the roadway for the movement of vehicles, exclusive of shoulders and auxiliary lanes. TRACTOR/SEMI-TRAILER -- A truck tractor that is pulling a semi-trailer. TRACTOR/TRIPLES -- A truck tractor that is pulling a single semi-trailer and two full trailers. TRAFFIC CIRCLE/ROUNDABOUT -- An intersection of roads where vehicles must travel around a circle to continue on the same road or to any intersecting road. TRAFFIC CONTROL DEVICE - INOPERATIVE OR MISSING -- A traffic control device which is not working or is not present. TRAFFIC CONTROL SIGNAL -- A device which controls traffic movements by illuminating systematically a green, yellow, or red light. TRAFFICWAY -- Any land way open to the public as a matter of right or custom for moving persons or property from one place to another. TRAILER LICENSE PLATE NUMBER -- The number or other characters, exactly as displayed, on the registration plate or tag affixed to the trailer. TRAILER REGISTRATION STATE AND YEAR -- The State, commonwealth, territory, foreign country, Indian nation, U.S. Government, etc. issuing the registration plate and the year of registration as indicated on the registration plate displayed on the trailer. TRANSPORTED TO MEDICAL FACILITY BY -- Type and identity of unit providing transport to medical facility receiving patient. TRUCK TRACTOR (BOBTAIL) -- A motor vehicle consisting of a single motorized transport device designed primarily for pulling semitrailers. TRUCK/TRAILER -- A motor vehicle combination consisting of a single unit truck and a trailer (a vehicle designed for carrying property and so constructed that no part of its weight rests upon or is carried by the towing road vehicle). UNDERRIDE/OVERRIDE -- An underride refers to a vehicle sliding under another vehicle during a crash. An Override refers to a vehicle riding up over another vehicle. Both can occur with a parked vehicle. UTILITY POLE -- A pole or post constructed for the primary function of supporting an electric line, telephone line or other electrical-electronic transmission line or cable. UTILITY ZONE -- See Work Zone. VAN/ENCLOSED BOX -- A single-unit truck, truck/trailer, or tractor/semi-trailer having an enclosed body integral to the frame of the vehicle.

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VEHICLE AUTHORIZED SPEED LIMIT -- Authorized speed limit for the vehicle at the time of the crash. The authorization may be indicated by the posted speed limit, blinking sign at construction zones, etc. VEHICLE BODY TYPE -- The general configuration or shape or a vehicle distinguished by characteristics such as number of doors, seats, windows, roof line, hard top or convertible. VEHICLE CONFIGURATION -- Indicates the general configuration of vehicle. VEHICLE IDENTIFICATION NUMBER -- A unique combination of alphanumeric characters assigned to a specific vehicle and formulated by the manufacturer. VEHICLE LICENSE PLATE NUMBER -- The number or other characters, exactly as displayed, on the registration plate or tag affixed to the vehicle. For combination trucks, vehicle plate number is obtained from the power unit or tractor. VEHICLE MAKE -- The distinctive (coded) name applied to a group of vehicles by a manufacturer. This information also can be obtained separately from the Vehicle Registration File. VEHICLE MODEL YEAR -- The year which is assigned to a vehicle by the manufacturer. Usually it is the year in which the model change occurs. This information also can be obtained separately from the Vehicle Registration File. VEHICLE REGISTRATION STATE AND YEAR -- The State, commonwealth, territory, foreign country, Indian nation, U.S. Government, etc. issuing the registration plate and the year of registration as indicated on the registration plate displayed on the vehicle. WARNING SIGNS -- Signs used to warn traffic of existing or potentially hazardous conditions on or adjacent to a road. WATER (STANDING, MOVING) -- Water in the road either standing still or moving which is there because of flooding. WEATHER CONDITION -- The prevailing atmospheric conditions that existed at the time of a crash. WORK ZONE -- A section of road marked to warn motorists that construction, maintenance, repair or utility work is being done. A work zone extends from the first warning sign to the end construction (work) sign or the last traffic control device. Work zones may or may not involve workers or equipment on or near the road. A work zone may be stationary (such as repairing a water line) or moving (such as re-striping the centerline); it may be short term (such as pothole patching) or long term (such as building a new bridge). WORK ZONE RELATED -- A crash that occurs in or near a work zone or involves vehicles slowed or stopped because of the work zone even if the first harmful event was before the first warning sign. WORN, TRAVEL-POLISHED SURFACE -- A road surface which is well used and shinny.

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Appendix G

Long Form

HSMV-90003

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Appendix H

Update/Continuation Form

HSMV-90004

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Appendix I

Narrative/Diagram Form

HSMV-90005

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Appendix J

Short Form

HSMV-90006

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